With fewer resources at their disposal, smaller, physician-owned practices are slower to adopt health information technology than other organizations with more money, staff and technical know-how.
Although the use of IT in small primary care practices has grown, factors such as practice size, ownership and the availability of financial incentives influence the extent to which practices adopt new technology, according to a study published in the Annals of Family Medicine.
Researchers conducted 40-minute telephone surveys at 566 small primary care practices with eight or fewer physicians; the first interviews were conducted from 2007 to 2010 and the second round from 2012 to 2013. They asked about 18 measures of IT functions, including record keeping, clinical decision support, patient communication and health information exchange with hospitals and pharmacies. Overall, practices significantly increased the use of 16 functions and decreased use of only two: electronic access to laboratory results and to clinical information on patient visits to the emergency department.
The study showed a dramatic increase in the use of IT by small practices. For instance, practices using all-paper medical records and having no electronic health record dropped by half from 66.8% to 32.3%. The initial survey found just 25% of practices digitally transmitted prescriptions directly to pharmacies, a number that increased to 70% in the follow-up survey. Practices that allowed patients to view their medical record online increased from just 1% to 19%.
Compared with physician-owned practices, hospital-owned practices used more IT processes. Among smaller practices, those with three to eight physicians were also more apt to adopt IT processes than those with only one or two doctors.
Practices that have external incentives—participation in pay-for-performance programs, in public reporting of quality data, and that receive a larger proportion of revenue from Medicare—also had greater adoption and use of IT.
Despite increased use of IT, the researchers found ample room for improvement. Fewer than 50% of practices used most EHR functions, and just one-fifth of practices used email to communicate with patients or allowed patients to see online medical records. Maintenance of electronic registries for the management of chronic disease was also low for all practices.
There may be good news for the future. The study authors point out that the new Medicare Access and CHIP Reauthorization Act (MACRA) will provide payment incentives and technical support to speed IT adoption and use by small practices.
However, a Government Accountability Office report last year said small and rural physician practices will face greater challenges to participate in Medicare’s value-based payment models, including MACRA.
More than two-thirds of small physician practices also foresee the loss of their independence by closing their doors or selling to larger groups due to MACRA requirements and related technology issues, according to a Black Book Rankings survey.