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Free Computers Not Enough To Get Doctors Using Technology

Getting small physician's offices to use computers and digital records is critical to improving health care and lowering its cost, but many remain reluctant.

When it comes to getting doctors to embrace computers, sometimes even free isn't cheap enough, Leonard Schaeffer, chairman and CEO of WellPoint Health Networks Inc., has learned.

The health plan Wellpoint earlier this year provided $42 million worth of free PDAs or PCs to help entice doctors to adopt E-prescriptions or reduce paperwork by submitting claims electronically. Although WellPoint contracts with 25,000 doctors, only 19,000 physicians participated--one in four passed on the free gear. A big part of the problem is keeping the technology running, rather than the initial investment. Less than 25% of doctor offices "have any IT support at all," says Schaeffer.

There's increasing interest and enthusiasm in the U.S. health-care community over the last several months to embrace electronic health-records systems and other information technologies that can reduce costs and save lives by reducing medical mistakes and inefficiencies. The health-care industry overall has lagged in adoption of IT compared with other industries. But the cure for doctors' reluctance to buy such technologies has been particularly elusive, and is vital to any change.

"If we don't have small physician's offices to be part of this, we fail," said Dr. David Brailer, the federal government's first health IT czar, during a presentation at the Health Information Technology Summit in Washington, D.C., Thursday. The federal government has set out a goal of having a national health IT infrastructure supporting electronic health records for most Americans within a decade.

Thursday's summit was sponsored by eHealth Initiative, a nonprofit organization with the mission of driving patient safety, quality of care, and cost efficiencies through IT.

Many doctors are reluctant to make financial investments in deploying and supporting the technologies because the bulk of the payback realized by these systems--reduced costs and healthier patients--don't benefit doctors financially, but predominately help payers, including Medicare and health plans. Also, the deployment of electronic-health records and other IT investments usually brings big workflow disruptions in doctors' practices, particularly among office staffers.

In recent months, the federal government and some private insurance companies have been investigating and piloting ways to get better buy-in from doctors, including offering physicians financial incentives, like pay-for-performance rewards to those doctors who use or improve patient care with IT, and low-interest loans to purchase new systems.

But WellPoint's experience is telling. Particularly disappointing was that of the doctors who took part, only 2,700 were willing to do E-prescriptions with PDAs, says Schaeffer. WellPoint had been hoping more doctors would've chose the PDAs since E-prescription software can greatly reduce medical errors, such as those caused by illegible handwriting. Overall, Schaeffer says less than 15,000 doctors in the U.S. are using E-prescription systems in their practices.

Lack of IT support is clearly a problem. Brailer says he believes that a tech cost price-point of $100 a month for IT doctor offices would provide "a pathway to growth" toward getting more doctors using digital records.

Brailer says progress is under way in helping the health-care community, including getting doctor offices and hospitals to embrace E-health record and other systems. That includes the recent award of about $139 million for more than 100 grants and contracts for health IT demonstration projects in 38 states by the federal Agency for Healthcare Research and Quality (AHRQ). AHRQ director Dr. Carolyn Clancy told summit attendees that the agency received so many interesting project proposals, "That we could've funded three times the number of grants awarded" had more money been allotted by the federal government for the programs.

The creation of Brailer's sub-cabinet position of National Health IT Coordinator this spring was considered a big move by the federal government in pushing an IT agenda in health care. The post was created through an executive order by President Bush; Brailer, a medical doctor and former health IT CEO in the private sector, was named to the post in May.

There are some in Congress who want to give the job more clout. U.S. Rep. Chris Dodd (D-Conn.) introduced a bill proposing moving Brailer's office into the White House reporting directly to the president, rather than to the Secretary of Health. "For Brailer to be more effective, he needs to have higher authority," says Dodd staff member Ben Berwick. Dodd's bill also recommends more than doubling the federal money spent on programs to help push the adoption of IT by doctors and others in the medical community.

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