Survey says cost, practice size determine EHR use

By: Joseph Conn / HITS staff writer

When it comes to electronic health-record system adoption, osteopathic physicians say cost is a key barrier. Practice size is a determinant in whether the systems are purchased and used, and penetration rates are likely to be quite low, perhaps still in single digits, according to a study released Tuesday. The study was prepared by the Center for Research at the Medical Group Management Association and funded by and at the behest of the American Osteopathic Association.

Overall, 31% of the osteopathic physicians surveyed had an EHR in their practices. Accounting for practice size, 55% of physicians in large practices of more than 50 indicated they had a computerized record system while 25% in solo practice reported they had an EHR.

The survey was conducted by the osteopathic association sending e-mail requests in June 2006 to 14,079 of its members asking them to complete a survey questionnaire online. The report said 907 members responded. In addition, workers from a professional survey company telephoned and questioned an additional 200 members who had not responded to the e-mail request for participation.

Researchers reported, however, that since the preponderance of respondents took the survey online, an electronic bias may have been introduced that skewed upward substantially the EHR penetration rate. According to the report, “Although 36.5% of the Web respondents used EHRs, only 9% of the phone survey respondents used EHRs. The use of an e-mail invitation with a subject line of “American Osteopathic Association Electronic Health Records Survey” is possibly a biased method for collecting data about electronic health record market penetration,” according to the report.

“Practices without EHRs might very well have self-selected themselves out of the respondent pool by thinking that the survey was intended only for those who used EHRs. This is one possible explanation for the higher penetration rate for the Web modality. The telephone survey, however, had a higher probability of getting responses from both EHR adopters and nonadopters. Thus, for this particular question about EHR market penetration, the telephone results might be more accurate than the Web results,” the researchers said.

EHR developers should take heart from the survey, particularly those vendors with systems designed for primary-care physicians in solo or small group practices where osteopaths abound. When it comes to the osteopath market of some 61,000 physicians, the game is still very much afoot, with no strong brand preferences showing.

Osteopaths surveyed reported using 113 different systems. No system among the top 10 had more than a 5.6% market share (No. 1, a tie, between Cerner Corp. and Epic Systems Corp.) or no less than a 2.6% market share (No. 10, NextGen). “Other” systems accounted for 64% of the market.

Survey participants ranked “lack of capital resources to invest in an EHR” as the No.1 barrier to adoption. The median cost, according to those with an EHR, was $20,000 per physician and $250 per month for system maintenance. Asked about the financial benefits vs. the costs, 22% said their practice costs decreased after implementing their systems; 22% reported their practice costs increased; and 36% indicated they were unaware of the financial impact EHRs had on their practices. When quizzed about what EHR-related services the association might provide its members, the highest-rated service requested—3.6 on a 5-point scale—was member discounts to buy and support the systems.

Sharon McGill, director of the department of quality and research for the association, said the lack of a market leader makes it impossible for the assoication to negotiate a volume discount for its members. “The range of all the EHR companies we use, there is not one that comes out as the No. 1 company,” McGill said. “I don’t think we’re looking for this report to give us a specific vendor we could work with more closely.” Advice and support to members during the selection process is a more likely function of the association, McGill said.

More than two-thirds of the physicians surveyed were in physician-owned practices while about 15% worked in practices owned by a hospital or integrated delivery network. Nearly 42% specialized in family medicine with another 6% in internal medicine.

According to the survey, 68% of those with EHRs were either “extremely satisfied” or “satisfied” with them, and 56% were similarly satisfied with their vendor’s service. Only 11% of respondents indicated they’d go back to paper if given the chance, while 76% would recommend their EHR to their colleagues.

Fully three-fourths of EHR implementations were for “self-contained system(s) operating on practice computers,” but historic physician resistance to Web-hosted systems seems to be easing in that nearly 21% of respondents reported their EHR used the application service provider model of implementation, while 4% listed “other.”

David Gans, vice president of the practice-management resources division at the MGMA, said that the survey showed no difference between results for osteopathic physicians and their allopathic counterparts, noting that in fact, “many of the osteopaths that responded are in group practices and they are with allopathic physicians.”

One thing Gans said he found heartening in the data was the high levels of satisfaction among EHR users.

“Virtually everyone who had an EHR didn’t want to go back,” Gans said. “I think as a message for doctors, there are substantial benefits; once you have gone through the pain of selection, learning and use, you’ll never go back.”

Gans also said that economics is the main reason behind the rising numbers of physicians using ASP systems.

“The ASP model means you don’t have to invest in as much hardware because the servers aren’t with you and, if you have an ASP, the service and maintenance is the responsibility of the ASP,” Gans said. “The upgrades are so much easier, so the operating costs in the short run and long run are less. One of the major barriers we identified is costs, and physicians are very bright people. It doesn’t take them very long to figure out that an ASP costs less. Many osteopaths are in small practices and an ASP gives them a low-cost option that they don’t have otherwise.”
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