A solo FP, Kay Lee, M.D., of Houston, bought her first electronic health record, or EHR, system in 2005. Within six months, she had transferred most of her patient records onto the new system, leading to better documentation, greater efficiencies and a higher level of care for her patients. But in 2010, Lee discovered that the manufacturer of her EHR was discontinuing the product line in 2011, putting an end to updates and technical support.
"We would be out there on our own," says Lee. "There would be no more support for what we were doing with our EHR."
Fortunately, she was able to lease an EHR system that had greater capabilities than her previous system. Unlike the old EHR, the new system has a patient portal that allows patients to access their own lab and test results, and it is equipped with patient reminders and preventive care features that are more user-friendly for Lee's practice.
According to David C. Kibbe, M.D., M.B.A., senior adviser to the AAFP's Center for Health IT(www.centerforhit.org), Lee's experience is indicative of the changes, challenges and opportunities that are occurring as a result of an evolving EHR market. Two years ago, he notes, the nation's EHR market essentially was frozen, slowed by inefficiencies, expensive products and a general lack of innovation.
But when Congress enacted the Health Information Technology for Economic and Clinical Health, or HITECH, Act in February 2009 as part of the American Recovery and Reinvestment Act, it invested $19 billion in health information technology, including $17 billion in incentives to encourage Medicare and Medicare physicians and other health care providers to adopt health IT. Another $2 billion was set aside as direct funding for the nation's health IT infrastructure.
That had an effect on the market's stagnation. "Any time the federal government puts nearly $20 billion in a market or industry, new products are bound to arise," says Kibbe.
The government also advanced policies and procedures to spur health IT adoption, and in the process, redefined and expanded the certification process for new and existing EHR products. Two years ago, says Kibbe, there was only one federally approved certifying company -- now, there are six.
In addition, notes Kibbe, "The certification process itself is much easier, more straightforward and less subjective."
The cumulative effect of the HITECH Act has been dramatic. In just the past several months, the number of EHRs on the market jumped from about 90 to more than 400. And, nearly 65 percent of these products are produced by companies with fewer than 50 employees.
"Ultimately, what this means is that the products and services physicians will be able to buy for their EHRs are going to become less expensive," says Kibbe. "They are going to be easier to implement and use, and a greater number of those product offerings will be Web-based applications in the cloud, so there will be less cost associated with their ownership and maintenance."
Steven Waldren, M.D., director of the AAFP's Center for Health IT, says family physicians should look for the following five core elements when choosing a vendor for electronic health records:
- ask for a list of FPs in a practice setting like yours;
- ask about the vendor's meaningful use certification, and make sure the certification applies to the product or module in which you are interested;
- ask about the vendor's plans and guarantees around stages two and three of meaningful use certification;
- ask for a demonstration on how you and your practice would collect, analyze, and report quality and performance data; and
- ask the vendor or vendors if they have working interfaces to other information technology systems used by your practice (e.g., hospitals, reference labs, practice management systems).
This, in turn, should spur health IT adoption, creating a critical mass of physicians and other providers who are using the technology within the next several years.
"We will be a country of physicians, hospitals and patients using EHRs as a routine matter of getting care," says Kibbe. "It is beginning now, and will happen more over the next five to 10 years. I would bet that in five years, 80 percent of doctors in this country will be using EHRs."
The short-term effect on family physicians of the push to use EHRs likely will not be as pronounced as it will be on other physician groups, says Kibbe, noting that more FPs -- about 60 percent -- are using EHRs already. Nevertheless, greater use of EHRs and health IT will provide an infrastructure for moving from a volume-based to a value-based health care system by enabling physicians and other health care providers to capture and use data to prove accountability and improve patient care.
"As a physician, you have to have access to information to deliver higher-quality care and to know what your outcome data are," says Steven Waldren, M.D., director of the Center for Health IT. "If you do a better job of taking care of your patients, you should get paid better, as opposed to seeing more patients to get paid better."
But for this to work across the system, there has to be a critical mass of EHR users, he adds.
Kibbe notes that the federal government has not dictated or prescribed which vendors of EHR systems physicians must use, and it has not mandated the type of EHR systems that must be used. Instead, the government has created a regulatory framework that uses defined meaningful use criteria to spur health IT adoption and to make the process work better.
The changes in the marketplace have not gone unnoticed by Andrew Schechtman, M.D., of San Jose, Calif., a faculty member with the San Jose-O'Connor Hospital Family Medicine Residency Program. In 2007, the residency program went through the process of choosing and purchasing an EHR, and now is back in the market for a new EHR.
"The demonstrations that we have seen recently are just leaps ahead in terms of usability and quality compared to the products we saw in 2007," says Schechtman. A process that might have taken 10 clicks of the mouse four years ago, now takes two clicks, saving time and money during the course of a day.
"It is the redundant and wasted tasks that get a lot of doctors frustrated with using EHRs," he adds.
In the meantime, the prices of EHR products also have fallen precipitously during the past four years, making this a good time for family physicians to jump in and start using the technology, Schechtman says. "I think the products have evolved to the point where they are not painful."
Despite Schechtman's optimistic outlook, the push to adopt health IT and EHRs has created a certain amount of anxiety and uncertainty in the physician community.
"Any time you get this many new entrants into the market place, it is confusing," says Kibbe.
He compares the current EHR market to the computer industry of the early to mid-1980s when numerous companies sold computer products, but only a few brands, such as Apple, IBM and Hewlett Packard, ultimately survived into the 1990s.
Waldren advises family physicians to "stay true to why you want to adopt the technology."
"Make sure it is the right thing for you and your practice and for you and your patients," he says. "And understand what things you want out of heath IT."