By Dena Bunis, CQ HealthBeat Managing Editor
January 13, 2011 -- Hospitals and primary doctors seem to be increasingly buying in to the notion of jettisoning paper files in favor of electronic record keeping, especially with the federal government dangling money in front of them in exchange for so doing.
Data from two surveys released by the Department of Health and Human Service's Office of the National Coordinator for Health Information Technology (ONC) shows that 81 percent of hospitals plan to meet the "meaningful use" requirement of the certified Electronic Health Records (EHR) standard and 41 percent of office-based doctors say they will as well. Among hospitals, two-thirds—65 percent—said they will enroll during Stage 1 of the incentive programs, in 2011 and 2012. Among office-based physicians, 32.4 percent said they would enroll during Stage 1.
"We were really pleasantly surprised at the proportion of hospitals and doctors that have the intent to do this," David Blumenthal, the national coordinator for health information technology, said in an interview with CQ HealthBeat.
Asked whether he is confident that providers will all follow through on their declared intent, Blumenthal said it's too soon to tell because the earliest they can qualify for meaningful use payments is April 1.
Provider registration for the Medicare EHR incentive program and some for Medicaid opened on Jan. 3. Most states will begin such registration for Medicaid this spring and summer.
"The best we can do is figure out what their intent is," Blumenthal said. "Intent is the beginning of action. Without the intent you're kind of lost. At least we're off to a good start."
The survey data, Blumenthal added, also revealed that the percentage of primary care doctors who have already signed up for the first phase of EHR went from 19.8 in 2008 to 29.6 in 2010. The primary physician category includes general internists, family practitioners, pediatricians and geriatricians, Blumenthal said.
"We want all physicians and all other clinicians to be users of electronic health records," he said. "We have prioritized primaries for technical assistance because they have lesser incomes and because they are in many ways the entry point to the health system and the coordinators of care for most Americans."
The 2009 economic stimulus law (PL 111-5) authorized the incentive payments through Medicare and Medicaid to doctors, hospitals and clinics that make "meaningful use" of technology. A federal regulation published in July spells out the specific criteria the government will use in determining who qualifies for such payments. HHS officials said high rates of adoption and meaningful use could mean $27 billion in incentive payments would be made over the next decade. Eventually, providers will face lower Medicare and Medicaid reimbursements if they don't get with the EHR program.
Doctors and hospital groups have complained that the meaningful use standards are too high. They've also voiced angst that the process is ramping up too quickly, emphasizing how difficult it will be for physicians and hospitals to adapt to the technology.
"The biggest concern we're hearing is that it's just a hard thing to do," said Blumenthal, who spent 30 years as a primary care physician before joining the Obama administration. A decade ago, Blumenthal said, the hospital he worked at converted to electronic records.
Doing this "requires technical facilities," he said. "It requires redesigning the work of an office, a nursing station or clinic. Change is hard." Blumenthal said he believes the change in work design will be more difficult for physicians than absorbing the cost of conversion.
"We're also hearing that there are a lot of choices to make among the different products, and that physicians are concerned they may not be making the right choice," Blumenthal said. To help them, ONC has created 62 Regional Extension Centers that will help providers choose products, install systems and attain the meaningful use standards.
"We knew and the Congress knew that these obstacles would be important and we tried to anticipate that,'' Blumenthal said.
Time could also take care of getting the conversion from paper to computer accomplished.
Electronic record keeping, Blumenthal said, "is definitely easier for younger physicians. They are going to be very reluctant to enter practices that today don't have electronic systems," and in most instances are learning to care for patients under such systems.
Blumenthal said his daughter is a third-year medical student at the University of Pennsylvania who had two recent hospital rotations. One had an EHR system. The other did not. When she worked at the hospital that still used paper, Blumenthal said, "she was lost in terms of how to find data and how to report data. That's going to be a pretty universal experience in the future."
The data released came from surveys commissioned by ONC and were done by the American Hospital Association and the National Center for Health Statistics, an agency of the Centers for Disease Control and Prevention.