Resistance To EHRs May Widen Healthcare Disparities

Small medical practices serving Medicaid patients have been reluctant to adopt electronic health records because they're already overwhelmed with providing medical services.
Neil Calman, president of the Institute for Family Health, wanted to know what the likelihood is of small practices either joining larger physician practices or closing their doors if they didn't adopt new technology. He also asked the panel how these practices will be monitored for HIT adoption and, if they are not supervised, what impact will that have on care for low-income populations.

"I don't know if we have an answer for that at this point," Hasselman said. She noted that many small practices don’t have computers and are struggling to provide basic healthcare services. Doctors at these practices are saying, "hey, don't even talk to me about HIT now. Help me with practice management, help me just to keep my shingle out, and then I can take a breath and get some breathing space and focus more on HIT or quality improvement," Hasselman said.

While these practices are small, they serve a large swath of the population, including large clusters of patients with diverse ethnic and racial backgrounds. For example, Michigan’s Medicaid data shows that approximately 50% of beneficiaries in Detroit receive care in practices of three or fewer providers.

"In many states and regions these small practices serve the majority of Medicaid beneficiaries, and they are under-resourced and disenfranchised from the larger integrated systems, and from quality improvement activities," Hasselman told the panel.

She also said small, high-volume Medicaid practices will be left behind if they're not either successfully engaged to participate in the incentive program or if Regional Extension Centers are unable to join with small practices as they develop new technological capabilities. "That would contribute to even greater disparities in health outcomes," Hasselman predicts.

Currently, several state Medicaid agencies and regional quality improvement alliances are exploring viable, effective, and sustainable solutions to support small Medicaid practices. Hasselman said these are encouraging signs, but stressed that more needs to be known about the size and type of these small practices and their resource needs.