Q and A With Dr. Molly Joel Coye
Healthcare Technology: Can you tell us a little bit about San Franciscos Health Tech?
Molly Joel Coye: HealthTech forecasts emerging technologies in biotech, pharma, IT and medical devices; that includes the timing of market entry, the nature of the products and services that will be offered and the potential impact and consideration in strategic planning for hospital-based delivery systems and health plan and federal agencies.
HCT: Is the lack of data standards the key obstacle to adoption?
MJC: I think that the lack of data standards is a key obstacle, a critical obstacle. But establishing data standards is like laying railroad tracks: You also need support for the investment for physicians because its not in the economic interest of a solo or small group practice to pay for an EHR. And you have to establish actual IT connectivity systems. This is what David Brailer is working on for the NHIN national network.
HCT: How do you think we can go about securing physician adoption?
MJC: For adoption of EHRs in large groups and IPAs (independent practice associations), pay for performance is probably almost enough incentive. Although uptake will still be slow, pay for performance allows them to submit data on their performance and to collect incentive payments for this, covering part of the cost of the IT needed to do the reporting. Indirectly, it allows them to earn some extra money to pay for their investment. Looser IPAs, ones that are not bound as a single business entity, and small groups and solo practitioners will need economic incentives on a pretty significant scale. The best estimates are that it will cost approximately $25,000 a year for two to three years for the initial capital investment and for the operating losses during the transition period and for incentives to make the whole thing worthwhile for physicians.
We need data standards, and vendors that produce products certified for those standards so that physicians can know that products they purchase will operate using the data standards and will actually exchange data with other systems. In terms of more general adoption of EHRs, you have to include nursing homes, healthcare agencies and other major provider groups beyond hospitals and physicians. In that larger world, safety net providers and those with very low margins will need some economic help in the financing, and all of them need help at least in the first two or three years.MedPAC voted in January as a recommendation to Congress that Medicare should pay for the use of IT for the first couple of years to get the capacity in place.
HCT: Do you think security is a barrier?
MJC: No, too many groups have fully adopted medical records in place and functioning well for that to be a serious barrier.
HCT: What do you think is on the horizon in the next five years?
MJC: For large medical groups, I suspect that at the end of five years they will be at the 80/20 rule, where 80 percent of them will have EHRs. A subset of IPAs that are close-knit economic entities will also have installed EHRs.We need to change the national leadership agenda to include more financing assistance for small group physicians I think that you will only be at around 40 percent at the end of five years.
