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7/15/2004
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Report: Time To Pay Doctors To Adopt E-Records

One of the industry's most-influential nonprofit groups says in a new report that doctors should be paid to adopt electronic records.

Doctors should get paid to adopt electronic records, and the medical industry needs to convince the American public that many health-care hassles could be solved through better IT, a report by an influential nonprofit group concludes. The report comes a week before the federal government will unveil its plan to help the United States' health-care community get connected electronically.

Connecting for Health, a private-public collaborative of more than 90 health-care organizations, makes recommendations in three key areas: creating a technical framework for connectivity; addressing the financial barriers inhibiting adoption of IT by health-care providers, especially physicians; and convincing the American public of the benefit of better, electronic access to their own health information.

The report, called "Preliminary Roadmap for Achieving Electronic Connectivity in Healthcare," hits themes that are likely to play a part in what's unveiled July 21 in Washington by new national health IT coordinator, David Brailer. Such a report from Brailer was called for when President Bush created the job and named Brailer to it in May, and will be a key part of a U.S. Health and Human Services health IT summit, with the theme of "Cornerstones for Electronic Healthcare."

Before becoming health IT coordinator, Brailer--a physician and former health-care company executive-- had been chairman of Connecting for Health's working group for legal, organizational, and financial sustainability.

Among the Connecting for Health's financial, organizational, and legal working group's recommendations in the new report are financial rewards to small and midsize ambulatory-care physician practices--the so-called front-line doctors, such as primary-care physicians--who deploy electronic health records.

Those physicians bear the brunt of the cost and organizational and work disruptions that occur with the implementation of electronic health-records systems. Yet in general, those doctors have the most limited financial resources to pay for those technologies, says Connecting for Health's chairperson, Dr. Carol Diamond. Also, unlike hospitals and larger health-care providers, smaller doctors' offices don't typically have IT support staffs to help deploy or maintain these systems.

And from a benefits perspective, payers such as insurance companies and Medicare get the biggest return from doctors' investments in electronic health-record systems, since IT helps reduce redundant medical testing and helps physicians better comply with insurers' drug formularies, and more. "There's a lot of work to do on the ambulatory side" to get doctors to adopt IT in their practices, says Diamond.

The recommendations to do that include financial incentives from employers and payers to reward doctors who use "basic" electronic health-record systems, with additional incentives paid for the use of "incremental" IT, such as advanced chronic-disease-management systems. The incentives could range from direct payments--such as payers paying the doctor an extra $3 to $6 per-patient if the doctor has deployed electronic health records--to indirect payments, or "pay-for-performance" incentives. Those could relate to doctors achieving quality-of-care goals that are "achievable only through the use of interoperable clinical IT systems," says the Connecting for Health report.

Some private insurers have already begun offering incentives for doctors to use IT, notes John Glaser, CIO at Partners Healthcare Systems and the person who took over Brailer's chairmanship on the incentives working group. Partners Healthcare, which operates two major Boston-area hospitals, is negotiating a plan with Blue Cross Blue Shield of Massachusetts to offer financial rewards of some kind for doctors who begin using electronic health-care records in three years. Blue Cross Blue Shield of Massachusetts plans to fund a pilot project to get one community in the state connecting with electronic records.

Glaser says that the federal government--because of its size as an employer and as a payer through Medicare--could have a huge impact if it gives incentives for doctors to use electronic records. "If the federal government does this, that would be a sign of credibility, that would be phenomenal," he says.

Connecting for Health's report starts with the idea that medical records will be scattered, so there needs to be a nonproprietary "network of networks" based on a decentralized framework that supports key standards. "Never will we have a common framework built on a single platform or vendor," says Connecting for Health's Diamond. "Health-care information is all over the place." The goal is to create standards that can enable the sharing and access of this dispersed information, she says. Such a system needs to safeguard patient privacy and not rely on a centralized database of patient records or a national patient health ID system.

As for engaging the American public, the Connecting for Health report recommends that the government and the health-care industry develop a core message that will "encourage American public to become partners in improving health care through the use of IT."

Diamond says Connecting for Health research has found that Americans "think health care is more automated than it really is." For instance, the public in general doesn't realize that problems they face--like when their doctor doesn't have a patient's latest test results or other information--"is something that IT can solve," she says.

At next week's federal summit, Brailer will present a "progress report on a strategic plan for the adoption of a national health information technology infrastructure," according to Health and Human Services. President Bush created Brailer's new sub-cabinet post to help propel Bush's goal for "most" Americans to have an electronic health record within the next 10 years.

Diamond says her organization doesn't know what Brailer's government report next week will propose, and says Connecting for Health's report was prepared independently. However, some Connecting for Health members are participating on panels and in meetings at the government health IT summit next week, she says.

The report is available online here.

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