As many as 20 percent of Louisiana's physician practices may not implement electronic health records despite a massive push for the technology, the chief executive officer of the state's Medicare Quality Improvement Organization said.

 

"Our physician workforce is aging and aging rapidly," said Gary Curtis, Louisiana Health Care Review Inc., chief executive. "There's a significant portion, I believe, of that workforce that will be leaving their practices within seven years."
Many of those physician practices are looking at how much time they have before retirement, and the cost and time it takes to implement an electronic health record system, Curtis said. Those physicians are looking at how long it will take them to recoup the cost for the technology.

 

The American Medical Association has estimated EHR costs at around $50,000 per physician. Last year, the Congressional Budget Office put the total costs for a typical office-based system at $25,000 to $45,000 per physician with annual maintenance costs in the range of $3,000 to $9,000 per physician.

 

 "Let's say there's probably 5,000 practicing physicians in Louisiana, and 4,000 that are probably the real targets of EHR implementation," Curtis said. "The question is how far will it ramp up to that? And I can't really answer that question. I think it changes as rapidly as you can calculate it because you have 4,000 moving targets."

 

Curtis said the quality improvement organization has worked with more than 300 practices this year to help them do the groundwork to learn about EHRs, their benefits, the time it takes to put them in place and costs.
Curtis also said he and the Health Care Review's board worry that a lot of physician offices will fail in attempting to implement the technology.

 

In order to successfully employ the technology, a physician has to understand which electronic health record would be best for his or her practice according to Curtis. The needs of a sole practitioner in a rural area are quite different than for a physician in an urban area whose practice may be tied to a 300- or 400-bed medical facility.

 

The problem is that physician offices have typically been happy to rely on a vendor's assurances that their product offers the optimum solution, Curtis said. And often the vendors' main interest is their bottom line.

 

Chris Williams, a team leader and quality improvement specialist, said that's where the Health Care Review can help.

 

Williams said the review can offer physicians an honest opinion that's also free and help the practice make the right decision. The review can help physicians assess their needs and answer questions about everything from work flow and transitions to planning and phases along the adoption cycle.

 

Three of the more important variables a physician should consider are the time period to implement the records, the choice of vendor, and the cost of the system Williams said. The physician has to know how well the practice can tolerate change and how to prepare his or her staff for that change.

 

Curtis said a physician office is probably one of the more conservative cottage industries in the country.

 

He said that many have been operating the same way for many years. The staffs may not have had the training necessary to adequately implement the new technology, and that can create a threatening environment for the employees.

 

Williams said it's also important to choose a vendor who's prepared and able to handle what will likely be a huge demand for services given the stimulus dollars at stake.

 

The stimulus bill included measures to help providers pay for the systems –$44,000 through Medicare or $63,750 through Medicaid in incentives to physicians – and Medicare penalties for failing to adopt them.

 

Finally, the practice has to consider the costs, Williams said.

 

Williams said in an ideal situation, a practice with three to five physicians, could implement an electronic health record in six to nine months. With a larger practice, the time frame could be significantly longer.

 

Curtis said that all the changes can slow down a physician's practice, which directly affects the doctor's income.

 

"If it slows down too much, you have a train wreck. And when that happens, you have a physician telling all of his buddies, 25 to 50 people, about what a bad experience he had," Curtis said.

 

That bad experience can discourage other physicians from adopting an EHR he said.

 

"I think the business community and the larger payers have to be pretty united in a voice that says, 'We really need our physicians to respond to this. We'll support you while you do it, and we'll recognize you for that achievement,'" Curtis said.