EMRs, operational assistance and physician practice size

Electronic Health Records: How to Spend the Money Wisely - Bits Blog - NYTimes.com

Fifty clinical leaders submitted a letter to the White House arguing that 1) EMR is necessary to improve quality 2) Most physicians are in small practices therefore 3) the "challenge is going to be all about implementation"

So are most physicians in small practices?

Yes - but there's consolidation of physician practices.

The proportion of physicians in solo and two-physician practice decreased significantly from 40.7 percent to 32.5 percent between 1996-97 and 2004-05, according to a national study in August 2007 from the Center for Studying Health System Change (HSC). Physicians increasingly are practicing in mid-sized, single-specialty groups of six to 50 physicians. Despite the shift away from the smallest practices, physicians are not moving to large, multispecialty practices, the organizational model that may be best able to support care coordination, quality improvement and reporting activities, and investments in health information technology.

What's the implication for EMRs?

The letter is correct to state that these small physician groups are going to need assistance in implementing EMRs - a process that typically a one to two year process and decreases physician productivity (thus revenue). However, again, even if you look at the Stark Law relaxation which essentially allows physicians to receive EMRs from their employers (prevented previously b/c of antikickback concerns), free has not been good enough. Another example which I can't pull the hard data from at this moment is eprescribing - a large midwest payor gave away eprescribing, and uptake was abysmal, even though free, because the product supposedly did not improve physician productivity, revenue or quality of care.

The value just isn't there for physicians to adopt EMR as is - the product itself needs to evolve to help in performance, not just in connectivity. Operational assistance is only part of the problem here. Follow the EMR tag on this blog, and you can find some more explanation on this concept.