California IPA's frustration is a caution on the road to meaningful use

Could the federal EMR stimulus signal the end of the small practice, or is it a wake-up call to vendors to improve their products? Could it be the catalyst for real payment reform? Patty Page LaPenn, CEO of Memorial Healthcare IPA, an organization of four independent practice associations in Long Beach and Orange County, Calif., seems to imply that it's a little bit of all three.

In part one of a lengthy interview with Healthcare Informatics, LaPenn talks of how Memorial has built an application to pull together numerous best-of-breed components to help small physician offices land Medicare bonus money. "We are actually rolling out a modular application we have built that will go a long ways toward meaningful use, because the cost of rolling out an EMR in a practice of one or two doctors is almost impossible to support," she says. "The large vendors don't want to deal with them."

Memorial's strategy is to go after the proverbial low-hanging fruit, providing access to eligibility, laboratory reporting and e-prescribing data, while putting off clinical documentation until later. "Most of the EMRs that are out there, it's like they have programmed what the doctors do now rather than thinking about how we can make it easier for the doctors to do things. There's been no paradigm shift creating built-in intelligence," LaPenn says.

"What our doctors who have deployed EMRs have found is that they have to do things themselves which they used to delegate, so it's taking them longer at the end of their day. We're focusing on what takes them longer at the end of the day and trying to actually automate this stuff," she adds. Of particular concern is the phenomenon known as alert fatigue. "Don't interrupt the doctor when they're in the middle of talking to a complicated patient to say, 'The patient hasn't had a mammogram,'" LaPenn says.

"If everybody feels it's really important for women to have mammograms, women to have pap smears, and men to have prostate exams, then charge them a different insurance rate if they don't do that, and give them direct referrals."

LaPenn easily could be speaking on behalf of any practice anywhere in the United States, and she illustrates why getting full value out of the federal stimulus is going to be so difficult. - Neil