Physicians have limited knowledge of the American Recovery and Reinvestment provisions, according to a recent online survey of 1,001 physicians, and they are still reluctant to adopt information technology.

Ingenix, a healthcare IT company and consulting firm, is under the umbrella of UnitedHealth Group, conducted the survey.

While financial incentives and penalties drive physicians to adopt health IT, the survey showed, they continue to be worried about upfront cost and workflow disruption.

The survey showed more than half, or 58 percent, of the respondents have little or no familiarity with ARRA, with 42 percent indicating some familiarity.

Eighty-two percent cite investment reimbursement as a motivator for implementing an electronic health record system, with 77 percent citing penalties as a motivation to implement.

Not surprisingly, cost and workflow disruption were listed as the two greatest risks for EHR deployment, with 82 percent citing cost and 74 percent citing workflow disruption.

The shift to adopt health IT is happening - thanks to the stimulus funds and CMS incentives - albeit slowly, said Kim LaFontana, vice president of Ingenix. "There is a growing awareness that the reason to adopt makes sense," she said.

The industry needs to educate the independent physicians who have not had a compelling business case to adopt in the past, LaFontana said. The legacy vendor community has largely focused on the multi-specialty, complex healthcare systems with deep pockets, she said.

With ARRA and a larger market of small physician offices, vendors have an incentive to develop innovative next-generation electronic health records, she said. Hosted EHRs with monthly subscription fees are providing much-needed new business and technology models for independent physicians.

The way physicians are educated on health IT and EHRs also needs to change, LaFontana said, adding, "This is an opportunity to start talking about capabilities in the physician's office."

Technology should be seen as an enabler that brings new capabilities and efficiencies to a physician's office, she said. Physicians will be more receptive to health IT if the conversation is around better care and more efficiency of the whole system.
For instance, physicians would value an EHR with its ability to identify their diabetic patients who have not had a hemoglobin A1c screening test in the past year.

The primary care physician's world is changing rapidly, LaFontana said. Fee and reimbursement schedules are changing, models of care such as the patient-centered medical home are being introduced, reporting quality meausures is required for participation in pay-for-performance programs. The small physician offices are overwhelmed with administrative complexity, clinical protocols and revenue cycle management issues, she said.

Legacy vendors have under-invested in the small group practices in the past. "You have to look at the entire physician's office," LaFontana said. Vendors and independent physicians need to establish the foundational capability in the office and the workflow around that in order to reap the benefits of health IT implementation.

To address the issues brought up by the survey results, Ingenix will be delivering a series of Webinars and unveiling a new Web site to  provide information and education to help small physician offices think about IT and its capabilities and improve their practices.