Almost every plan to improve health care -- from members of Congress, insurers, employers and President-elect Barack Obama -- contends that new IT, including electronic health records, electronic prescribing and telemedicine, will save time and money.
But will health Information Technology (IT) make practicing medicine more satisfying?
Eventually, but it's going to take a while, and it won't be easy or inexpensive, according to a representative of the Healthcare Information and Management Systems Society and the president of The Physicians' Foundation, which recently released a national survey measuring doctors' opinions about the profession.
The Physicians' Foundation survey indicates widespread frustration among primary care physicians. They feel overworked and nearly half of them plan to cut back on the number of patients they see or quit medicine entirely, according to the survey.
Neither John Maese, chair of the HIMSS Ambulatory Care Steering Committee and president of Quality Physician Services in Brooklyn, N.Y., nor Lou Goodman, president of The Physicians' Foundation, see health IT as a panacea for all that ails the medical profession, but both agree it can be a valuable tool.
Goodman, however, is worried there soon may not be enough primary care physicians, regardless of new technology.
"Going into this project we generally knew about the shortage of physicians," Goodman said, adding, "What we didn't know is how much worse it could get over the next few years. The bottom line is that the person you've known as your family doctor could be getting ready to disappear -- and there might not be a replacement."
Initial Investment of Time and Money
Maese said that health IT can help make the practice of medicine more rewarding but that it takes an initial investment of time and money.
"Initially, technology slows you down," Maese said, adding, "So in the face of declining reimbursement that requires you to see more patients per hour, it can be very frustrating to start up with technology."
Maese said, "Younger physicians who have grown up with a computer find it easier to transition to technology." He added, "Older physicians who do not have that experience initially have to carve out time to learn basic computer skills and then the new software."
In its survey, mailed to 270,000 primary care doctors and 50,000 specialists, The Physicians' Foundation asked, "Have you already implemented an electronic health record?" Among the almost 12,000 responses, 72% answered "no" and 28% answered "yes."
"Time, money, personnel and expertise are the major barriers to widespread adoption of technology in medical practice," Goodman said.
Of those who said they had not moved to EHRs, 77% cited lack of money, 69% cited lack of expertise or other resources and 61% cited lack of time.
Although the survey did not specifically address physicians' opinions of health IT, Goodman said his sense is that most physicians look forward to the advancement it represents.
"I think many physicians are very interested in adopting new technology and many have already taken the next step," Goodman said.
"There is great interest and continued excitement over the potential improvements technology holds. [Health IT] is clearly on the front burner in the early discussions in the Obama cabinet as part of its proposed health system reform efforts," Goodman noted.
The Physicians' Foundation was founded in 2003 as part of a settlement in an anti-racketeering lawsuit involving insurers, physicians and medical societies. The foundation conducts research and acts as an advocate for physicians and physicians groups.
More Seed Money Needed
Maese and Goodman said increasing payments to help offset investment costs for technology would help make technology spread more rapidly.
"We believe that the large initial investment in technology without the concomitant adjustment in payment rates makes it very difficult for private practice to install an [EHR]," Goodman said, adding, "Even large group practices have seen challenges with questions of interoperability and the significant outlays of time and money required to get a system up and running."
Maese agrees. "There needs to be increased financial support for the EMR, the initial purchase and the ongoing maintenance of the EMR," Maese said, adding, "Currently, small practices, where most health care is delivered, do not have the economic ability to purchase the hardware, the software as well as the additional expense of electrical wiring upgrades and high speed Internet access to make an [EHR] work."
Five Ways Information Technology (IT) Can Help
Once the initial learning curve is negotiated and hardware and software are in place and working, Maese lists the following five ways new technology can make a physician's life more satisfying:
• "The computer may not save them time but there is a feeling that there is a higher quality of care rendered and better patient safety. This is very satisfying to the physician."
• "Reduction of the hassle factor. You are able to deal with insurance or formulary issues at the point of care so you do not have to go back after the patient has left the office and redo the request for a medication or a service."
• "Improved time management or flexible time management. Electronic medical records that can be accessed from home gives the physician more flexibility. The physician can attend meetings and events without having to go back to the office to complete medical records or carry charts back and forth to have them completed."
• "Better access to care for patients in an emergency. Electronic records can be accessed from anywhere."
• "More family time. Once the physician has completed seeing all the patients, the physician can go home, see the family and complete chart documentation remotely. In addition, follow-up care, checking diagnostic tests and X-rays can be done at home, which again allows the physician flexibility to spend more time with the family, which helps increase overall lifestyle satisfaction."
by George Lauer, iHealthBeat Features Editor
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