Asymmetric benefits hinder EMR adoption

Overall penetration of the electronic medical record is relatively low in the U.S. And the gap in its adoption between large, well-financed organizations and smaller, cash-strapped physician practices is even larger, according to presenters at the American Medical Informatics Association meeting in Boston.

Implementing an EMR is expensive, involving not only large capital outlays but ongoing operating expenses. For large healthcare institutions, finding the money may be difficult, but it isn't impossible. Implementation is a different story for many small practices.

A March 2005 National Ambulatory Medical Care Survey found that the rate of EMR adoption stands at 17%. That rate is only 7% for small offices, according to a September 2004 report from the Center for Studying Health System Change.

"Closing the adoption gap is critical," said Dr. David Brailer, national health IT coordinator, during the opening plenary session of the AMIA's spring congress.

The decision to implement an EMR is complex and can be a function of an organization's size, financial wherewithal, and technical capability, he said.

During a question and answer period, attendees noted that government and other payers need to address current structures of reimbursement that go against the adoption of EMRs by providers, especially in small offices.

At this point, the government is not going to intervene with EMR implementation in small offices, leaving it to the market to push adoption, Brailer said.

Dr. Blackford Middleton, program chair of the spring congress and corporate director of clinical informatics R&D at Partners HealthCare in Boston, related how an EMR can provide savings for an organization, streamlining business processes and improving information access.

"But who benefits from these savings? The providers who are paying for these technologies are not experiencing the majority of the gain. There's an asymmetry in the market, and I would suggest that the market is not working for the small office environment. I would disagree with David Brailer on that," Middleton said.

Some methods could drive EMR implementation in small offices, he said, including participating in pay-for-performance scenarios or other types of quality incentive programs that could be done only with the adoption of IT.

"Or we could look for reimbursement from a federally funded small loans program, similar to student loan programs," he said.

For more information from the online Diagnostic Imaging archives:

'One size fits all' does not apply to EMR implementation

IHE concept extends to electronic health records at HIMSS 2005