Perceptions of an Organizing Vision for Electronic Medical Records by Independent Physician Practices

Introduction

The Advanced Technology Program (ATP) of the National Institute of Standards and Technology (NIST) promotes using information technology (IT) systems in the healthcare industry as a means to deliver substantial cost savings, to improve the quality of healthcare, and to capture global market share of new and improved products and services (NIST, 2005); the Institute of Medicine (IOM) highlighted IT as integral to improving healthcare (IOM, 2001); and, the U.S. Government in general has promoted increased use of health information technology (HIT) (WHSOU, 2008, 2007) and in particular has outlined a plan that seeks to ensure that most Americans have electronic health records (EHR) by the year 2014 (WHSOU, 2006, 2005, 2004). In addition, Health and Human Services (HHS) Secretary Mike Leavitt recently described how electronic medical records (EMR) can help change the macroeconomics of the way small physician practices are reimbursed thereby facilitating improvement in the delivery of healthcare (Burda, 2008).

Despite these high expectations for the value of IT in healthcare, HIT use in the U.S. is low in the sheer number of adopters as well as in the extent of actual use (Poon et al., 2006; Johnson, Pan, & Middleton, 2002). Studies from the Center for Studying Health System Change (HSC) show wide variation in IT adoption across physician practices, particularly by physician practice setting, size, and specialty. That is, in the 2004 to 2005 timeframe, U.S. physicians in traditional practice settings i.e., primarily solo or relatively small group practices where the vast majority of Americans receive care, reported that their practice generally confined IT use to five clinical function areas: obtaining treatment guidelines (65%), accessing patient notes (50%), writing prescriptions (22%), exchanging clinical data with other physicians (50%), and exchanging information with hospitals (66%) (Cory & Grossman, 2007). Since only those physicians with access to IT for all five of these clinical activities are considered to have an EMR the issue of adopting an EMR based on lack of support is an important issue for small practices. That is, typically the highest levels of IT support for patient care are found in staff- and group-model health maintenance organization (HMO) practices, followed by medical school faculty and large group practices (Johnson, Pan, & Middleton, 2002).

In particular, the adoption and use of EMRs by independent physician practices is well below expectations. For example, in a random survey of nonfederal, office-based physicians providing direct patient care, Burt et al. (2007) found that just 24% of physicians used EMRs in their office-based practices; in a survey of primary care physicians, Menachemi and Brooks (2006) found that 24% overall reported electronic health record (EHR) use in the office; and, in a national, representational survey of physician practices Gans et al. (2005) found that just 14% of practices overall used EMRs. In addition, whereas recent estimates of EMR adoption indicate that the actual number of adoptions has increased from about 105,000 physicians to 130,000 physicians, this increase still represents just approximately 20% of the overall general physician population (iHealthBeat, 2005).