Financial, Technical Support Are Keys to Health IT Adoption by Small Physician Practices

The American Recovery and Reinvestment Act of 2009, or ARRA, will spur the adoption and use of health information technology, or health IT, among small physician practices by giving them much-needed financial and technical support to implement health IT systems. Without this kind of assistance, many small physician practices will find it difficult, if not impossible, to adopt health IT and electronic health records, or EHRs.

That was one of the main messages delivered by AAFP President-elect Roland Goertz, M.D., M.B.A., of Waco, Texas, and other witnesses who testified July 27 (7-page PDF; About PDFs) before the House Energy and Commerce Committee's Subcommittee on Health.

"H(ealth) IT is critical to improving quality and effectiveness of patient care," Goertz told committee members during the hearing. He added, however, that "physicians in small, rural practices must receive technical support during implementation and use of (health) IT."

One portion of the ARRA, known as the Health Information Technology for Economic and Clinical Health, or HITECH, Act, focuses on promoting the adoption of health IT among hospitals, physicians and other health care providers. HITECH authorizes $2 billion in grants for the creation of several programs to spur health IT use, including a beacon community program, a health IT workforce program and a health IT extension program.

HITECH also provides incentives under both Medicare and Medicaid for physicians and other health care providers who meet "meaningful use" criteria. On July 13, CMS issued a final rule defining the meaningful use objectives that must be met to qualify for the financial incentives.

"We believe that the recent meaningful use regulations will support what the AAFP already has been doing for years," said Goertz. "Our focus has been to ensure that the meaningful use rules are achievable for physicians in small and medium-sized practices and improve patient care. Our members want to accomplish what Congress intends."

"Solo, small rural practices, in particular, are short of time and dollars," said Goertz. "They are busy focusing on patient care and operating on small margins. Assisting them is critical to making (health) IT work in the U.S."

Therefore, Goertz said, "the HITECH grants are critical, as physicians make these transformative changes to their practices."

Among other witnesses who testified during the hearing was family physician Matthew Winkleman, M.D., (3-page PDF; About PDFs) of Harrisburg, Ill. In his testimony, Winkleman agreed that one of the obstacles many physicians face when trying to decide whether to deploy an EHR is the "initial upfront costs."

"Not only is the software, hardware and necessary infrastructure costly, but the process of seeing patients in the initial weeks of transitioning to use of an electronic record requires changes in workflow that will likely decrease efficiency and the number of patients seen daily," said Winkleman, who is one of the physician owners of the Primary Care Group in Harrisburg.

Goertz also addressed another component of HITECH, the health IT extension program, which provides technical assistance, guidance and information on best practices to support and accelerate the efforts of physicians and other health care providers to become meaningful users of EHRs.

"I think of the regional extension centers as a comprehensive support team for small practices," Goertz testified. "These centers will provide not only technical assistance, but general information when these small practices need help."

He called on Congress to "closely monitor the implementation and resources of the regional extension program as they are essential to the success of these practices."

David Blumenthal, M.D., M.P.P., the national coordinator for health IT within HHS, also testified (13-page PDF; About PDFs) before the subcommittee.

Blumenthal acknowledged the obstacles faced by small physician practices, saying "those are the practitioners who are having the hardest time." He added, however, that the regional extension centers are geared toward small physician practices.

"We are beginning to enroll 100,000 small practices into the regional extension program," Blumenthal said. "That is going to be a big opportunity for small practices," he said.

Goertz, who is the CEO and executive director of the Heart of Texas Community Health Center in Waco, told the committee that he has been an EHR user for nearly 14 years.

Fourteen years ago, he said, several physicians working at the federally qualified health center were not comfortable with computers. But now, according to Goertz, "not one of our providers would return to paper records."

"We are absolutely convinced that our use of the EHRs has led to improved patient care and efficiencies," he said.