Most of the 1,500 largest U.S. hospitals have already deployed electronic health record systems. Not so for the nation's 700,000 practicing doctors. Less than 20% of them use EHRs, and many aren't using fully functional systems. So what's at stake if all these doctors don't get on board with deploying these systems? A lot.
Digitized records provide a timely, cost-effective way to share patient information. If physicians aren't using them in their private practices, they lose those benefits, as do the hospitals they work with. Paper records continue to be shuffled, putting patients at risk for medical mistakes, ill-informed treatment decisions, and unnecessary tests because hospitals and doctors don't have easy access to information about recent tests, health histories, and other important data.
There are looming financial implications as well. The Health Information Technology for Economic and Clinical Health Act, part of last year's stimulus legislation, provides more than $20 billion in incentives to doctor practices, hospitals, and other healthcare organizations that show they're making "meaningful use" of EHRs. A first round of rules defining what constitutes meaningful use was released last month and includes some requirements that providers be able to electronically exchange patient data; later stages of rulemaking are likely to include more stringent requirements.
At risk are incentive payments of as much as $64,000 for a physician practice. For hospitals with fewer than 50 beds, incentives could run as high as $2.5 million, and for ones with 500 or more beds, as much as $5.2 million, according to the American Hospital Association. Penalties for non-compliance start in 2015, when physicians and hospitals that treat Medicare patients would see a reduction in fee reimbursements.
Another blowback from not having doctors on EHRs could come from the healthcare reform legislation signed in February. It includes provisions for changing the way doctors who treat Medicare and Medicaid patients get reimbursed. Instead of being paid per service, they'd be paid, at least in part, based on quality of care. To the extent that their ability to efficiently exchange data affects care, there's added incentive to get on board with EHRs. What has doctors particularly worried is that private insurers are likely to follow the federal government's lead with payment reform.