It's no secret that U.S. doctors haven't rushed pell-mell to ditch all their paperwork and adopt electronic medical records. As we've heard repeatedly, money, resistance to change, money, concerns about obsolescence, money, and unanswered questions about how the whole system will work ("interoperability," or how one system will "talk" to another) are among the barriers.

But is it about to change? A new survey supported by the Robert Wood Johnson Foundation, conducted by the Institute for Health Policy at Massachusetts General Hospital and published online by New England Journal of Medicine, suggests we might be nearing a tipping point. As one doc put it, it's time to trade in the mule for a tractor.

Only four percent of the more than 2,700 doctors surveyed have a fully functional electronic health record system, (and another 13 percent have a basic system). But more than four in ten of those surveyed reported that they currently are setting up an EHR system or plan to do so within two years. And those figures were gathered by March, before Medicare's recent announcement of a $150 million pilot program to assist physicians, mostly in small practices, in 12 cities and states who want to go electronic.

"The physicians who now use these systems like them," the study's co-author Catherine DesRoches said. The new federal dollars should lead to progress, she predicted.

The survey found that primary care doctors were more likely to have electronic records than specialists. Younger docs (no surprise) were more comfortable with them than older ones, and bigger practices were more likely than smaller ones to have made the investment. They were also more common in the West. However, practices with lots of poor and minority or underserved patients were NOT less likely to have gone IT than others, an encouraging piece of news.

That doesn't mean there aren't still many obstacles. Interestingly, the survey found that 16 percent of physicians said their practice had purchased an EHR but had not used it yet (which evokes a mental image of unassembled toys on Christmas morning). Another fourth said their practice was planning on purchasing a digital recordkeeping system within the next two years. "Should that actually happen, we may be at a tipping point and we'll see a significant jump in adoption by then," DesRoches said.

The biggest barrier cited: two-thirds of physicians without EHRs cited affordability. Other reasons included finding the right EHR, concern about return on investment and that the system will become obsolete quickly.

Another finding that didn't surprise us: Other industrialized nations are ahead of us—including Denmark, the Netherlands, Norway, Australia, and New Zealand. The United Kingdom and Germany have made substantial progress.

The Wall Street Journal's blog got a lot of fairly heated comments from doctors and IT experts—from those who said they could never make it pay, to those who now can't imagine life without it. Here are two samples.

"Healthcare "Provider" - MD wrote:

The $40,000 set up fees [per doctor] and thousands of dollars in yearly maintenance is not "...without substance..."... We, less than 6 months ago, looked at 3 national vendors for a full EMR (not EMR-like SOAP notes or those placing "ads"). Yes, it DID come to $40,000 per physician + thousands of dollars of annual maintenance costs as the above article states.

 

 

 

 

But someone who called himself (or herself) RealDoc countered:

We spent a LOT less than $40k on our EMR, and we have already recouped our investment with reduced transcription and filing costs, improved efficiency. Taking care of patients is much easier when we admit to the hospital, since we can look at their entire record, problem list, med list, etc. Taking call [sic] for each other is TONS easier, since we can look at the records from home or from the hospital. Everyone is looking at new EMR costs, but not factoring in the lower costs of other items, plus the increased income from increased patient volume and better coding. Patients LOVE what we are doing—if they call they get somebody immediately who knows their case, and if they message us by web they avoid phone-tag.
This is like a farmer choosing between plowing with a mule and plowing with a tractor. Yes, the tractor is expensive, and it costs money to keep it running and money for fuel. The difference in results is like night and day, and until you do it you won't realize how bad off your were on paper.

 

 

 

 

We've written many times about our conviction that IT will lead to a more efficient—and higher quality— health system, and we hope Congress this year will approve legislation to make that transition faster and easier. Because it's definitely time to trade in that mule for a tractor.