Docs Find New Entry into Electronic Medical Records

By M.L. Baker  |  Posted 05-18-2005

Fewer than one in four physicians keep their patients' information in an EMR.

At this year's Toward an Electronic Patient Record conference, some 100 vendors of electronic medical record system came to tout their wares.

But for physicians working in offices with just a few practitioners, the biggest decision may not be picking a product but a payment model.

EMRs are expected to prevent medical errors and prompt doctors to provide better care, but doctors worry about costs and disruption.

Most physicians get an EMR system by purchasing software plus the necessary hardware to maintain patient data in the doctors' office.

But physicians using an ASP (application service provider) pay a monthly subscription to access EMR systems and patient data.

This model could even encourage greater connectivity between providers.

"The reason why you'd pick one versus the other probably has to do largely with how much internal IT support you have," said Bruce Kleaveland, COO Physician Micro Systems Inc, an EMR company offering both options.

Right now, smaller physician practices are much less likely to use EMR systems than their larger counterparts, but as smaller, more numerous practices turn toward IT, ASP could become more popular.

Girish Kumar is VP of sales and marketing at eClinicalWorks, which also offers both options.

Both Kleaveland and Kumar said the ASP option has become more popular over the past several months.

"The trend is coming from the one- and two-doctor practices," said Kumar, largely because residents moving into their own practice want EMRs, but don't want to deal with setting up servers.

The in-house model is expected to remain dominant. Kumar estimates that practices adopting ASP will grow from about 4 percent now to about 15 percent.

Depending on a practice's IT costs, the in-house model can cost less overall, but practices take less of a financial risk with ASP.

Physicians who don't want to make a long-term or big-cash commitment to EMR can try ASP for a year and decide if they like it, said Kleaveland.

For smaller groups, an ASP model "makes a lot of sense." said Michael Mytych, a consultant who helps physician groups select EMR systems.

Whether the level of service will be sufficient still remains to be seen, he said.

However, practices need to make sure that they have multiple lines of communication so that they can still get their data if one route gets knocked out, and they also need to make sure they understand how a service provider backs up data and how quickly that data could be made available.

Wesley Lewis, a Utah physician checking out EMR options for his 20-physician practice, says some aspects of an ASP make him and his fellow physicians uneasy.

He says he's worried about slow connectivity, access to data if his office loses power, and says he doesn't want to trust another organization to protect that information if disaster strikes.

In contrast, Neil Rawlins, a physician in Richland, Wash., said a Florida hurricane convinced him that ASP was right for his practice.

A Florida group he collaborated with went live with an in-house system three weeks before a storm destroyed their offices and their backup servers.

Rawlins also said the ASP model solved other problems like getting specialized IT staff to come out to his clinic and the cost of replacing servers every few years.

About 18 months ago, Rawlins' group of seven physicians approached Spokane Medical Association, which had a server farm running Logician (now part of GE Healthcare), about sharing costs for an EMR.

The result was a spinoff called Turnkey that provides a subscription-based EMR; Rawlins is its medical director.

None of the 10 or so people interviewed for this article said they thought security concerns were overwhelming.

Overall, barriers to ASP are falling, said consultants and vendors, who provide or advocate for both payment models.

High-quality connectivity is becoming more wide-spread, and getting multiple sources of connectivity is easier.

Though physicians are still uneasy about not having data in their backroom, they are becoming more comfortable.

"Both models will get the job done. I think some people overlook the ASP for superstitious reasons," said Kleaveland.

In fact, the ASP model could be part of cooperation among larger groups. A recurring theme at TEPR was that RHIOs (regional health information organizations) had no sustainable business model.

Mytych imagines that RHIOs could run more than one EMR options out of their data center and charge a fee for doing so.

eClinicalWorks' Kumar thought that RHIOs and IPAs (independent practice associations) might host EMRs for their clients and so accelerate the ASP model.

New applications, like patient portals, could also accelerate the model, since very few physicians' offices would want to host a public Web site.

Though it's still early days, the ASP model seems poised to be more than a lower-risk option for small physician practices to enter the market. It could be a part of bringing the larger health care community together.