FP Congressional Testimony Addresses Hidden Costs of Electronic Health Records

Congress should provide tax breaks and other incentives to help small physician practices buy and maintain electronic health record, or EHR, systems, said a family physician who testified before the House Committee on Small Business here on July 31.

Thaddeus Bort, M.D., of The Family Medical Group in Cincinnati, said, "the investment and utilization of health information technology, or HIT, should continue to receive some form of tax incentive or system of reward." He also called on Congress to sponsor an environment that provides incentives to make EHR systems interoperable, thus allowing for more reliable quality measurements and improvements.

"Both in spite of and because of our experiences, I believe the benefits of (EHRs) over paper charts are numerous and profound," said Bort. "But because of the substantial cost and time barriers, it is quite difficult for small practices to purchase (systems)."

Bort spoke during a committee hearing on the unforeseen challenges of incorporating EHRs into small specialty practices. He was joined on the panel by physician representatives from the American Association of Neurological Surgeons, the American Psychiatric Association, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists. During the hearing's question-and-answer segment, Bort said the recent enactment of a Medicare payment bill that includes financial incentives to encourage the adoption of EHRs was a "step in the right direction," indicative of the type of legislation Congress should enact to help small practices defray the cost of EHRs.

During his testimony, Bort described his experiences with EHRs, saying his practice of 12 family physicians purchased a licensed EHR system in 2006 and began the arduous process of transitioning from a paper-based system to an EHR-based system.

"Only our integrity and our desire to help our patients kept us on-task," said Bort, who described himself as a family doctor living and working in the trenches of primary care.

Bort said that he and his colleagues never anticipated the ongoing cost of developing and maintaining an EHR system. The practice, which takes care of more than 28,000 patients at three separate locations in southwestern Ohio, southeastern Indiana and northern Kentucky, purchased the EHR system at an initial cost of $228,000. This cost, however, did not include the transfer of paper files to an electronic format or take into account the loss of productivity resulting from the time and effort expended by staff members to learn the system. The practice also pays its EHR vendor more than $258,000 annually to maintain the system.

"There was 'sticker shock' over initial outlays, and then the ongoing outlays and enhancements as we got further into the system." Bort said during the hearing. "We were dependent upon it, so (we) were obligated to upgrade it."

Bort also described some of the benefits of the EHR system, saying it provides convenience, accuracy and completeness while enhancing privacy and confidentiality. "When I am with my patient in the exam room, I am able to access lab results and check past history -- all at the click of a mouse."

EHRs also are essential to supporting and sustaining the patient-centered medical home, a team-based health care model that emphasizes care coordination and the management of chronic diseases, which leads, in turn, to better health outcomes at lower costs, Bort said.

Bort and other members of the panel identified the lack of interoperability among EHRs as a major obstacle blocking the adoption of the systems.

"When our doctors visit patients at some of the hospitals, they are not able to access the patient information in our office because the hospital system and our office system are incompatible," he said.

"I would like to say we have achieved a paperless office," Bort said. "But we continue to be inundated with paper all day long. Our fax streams hundreds of prescription refill requests to us since there is no direct electronic communication between our system and the pharmacy or other providers."

Bort compared the current situation to the cell phone industry, pointing out that "there are multiple carriers, but if they did not communicate, we could not talk to one another. That is what we are living with at this point."

Ralph Hale, M.D., EVP of the American College of Obstetricians and Gynecologists, said the lack of interoperability poses the greatest threat to patient privacy. Without interoperability, providers cannot communicate electronically, requiring someone to move medical records from one file to another and raising the possibility of security breaches, Hale said.

House committee members shared the concerns raised by Bort and other panel members. Committee members also seemed to acknowledge that although EHRs result in cost savings for insurers, payers and the health care system as a whole, they do not necessarily save individual physician practices money. This makes it even more difficult for physicians to shoulder the cost of EHRs without some type of bonus or incentives.

"There is no silver bullet solution to America's broken health care system," said Rep. Nydia Velazquez, D-N.Y., chair of the Small Business Committee, during her opening statement. "There are, however, a number of ways to address the issue. For one, financial incentives to HIT users would help spur uptake."

Rep. Steve Chabot, R-Ohio, the senior Republican member of the committee, who also is Bort's patient, said, "the decision to implement health information technology in a small medical practice is considered an act of courage by many physicians."

Committee member Rep. Charles Gonzalez, D-Texas, meanwhile, said the federal government has "determined that HIT is an effective way of saving money," and would therefore continue to champion HIT initiatives.

"The train has left the station," said Gonzalez. The question, he added, is whether the federal government will factor in the experiences of physicians when making decisions about HIT. "I think (physician input) is totally essential or this is not going to work," he said.