Ease Burdens That Deter EHR Growth, FP Tells Congressional Committee

Congress must recognize the financial and time pressures that discourage small to medium-sized physician practices from implementing electronic health records and should step in with policies to ease those pressures.

That was the message taken to the House Small Business Committee's Subcommittee on Regulatory Reform and Oversight when FP Christopher Normile, M.D., of St. Charles, Mo., presented invited testimony during an April 6 hearing. Normile, a partner in a two-physician practice, described the reality of buying, implementing and maintaining an electronic health record, or EHR, system in a small medical office.

The cost of purchasing an EHR system ranges from $5,000 to more than $50,000 per physician, Normile told the subcommittee. But purchasing a system is only the beginning of the capital investment. Software, training and installation costs added, on average, $22,038 for each full-time provider using the system, and ongoing annual costs were an average of nearly $8,500 per provider, according to "The Value Of Electronic Health Records In Solo Or Small Group Practices," a study in the September/October 2005 issue of Health Affairs.

"Those of you who hate setting the clock on your VCR can't even imagine the complexity of installing and using the hardware and software required to run an already complex business," Normile testified. Physicians in small medical practices have a choice, he added. They can either hire computer consultants at $150 an hour -- which Normile noted is "more than three times my hourly income" -- or try to perform their own system maintenance.

The cost of implementing EHRs truly skyrockets when dwindling Medicare and insurance plan payments are taken into account. Not only must physicians take time away from patient care to address initial and ongoing EHR issues, they also must work with third-party payers who fail to compensate for that investment, he said.

"Currently, time I set aside for an electronic communication with a patient, whether it is to answer a question, check on compliance or send information, is gratis," said Normile. "We cannot be reimbursed by insurance or by Medicare, even if this electronic consultation is done in lieu of an office visit. Recognizing the value of ongoing communication and compensating the physician for all the time involved in caring for a patient will be an integral part of accelerating this technology."

Normile urged Congress to take action. "In order to accelerate adoption," he said, "AAFP recommends that Congress work to provide financial incentives for small to medium-sized practices, establish federal standards of interoperability, and support technical assistance programs to help small practices through the cycle of selecting, implementing and redesigning their clinical workflow."