Would 'free' EHR systems really help physicians?

May 15, 2006

Will physicians be more inclined to use electronic prescribing andelectronic health records if their hospital, group practice, oranother entity provide the necessary computers, software, andtechnical support?

The U.S. Department of Health and Human Services thinks it's possible. That's why it is moving toward loosening fraud regulations to encourage this kind of donation. But health providers, technical groups, and others have balked, claiming the HHS plans include too many restrictions.

At this point, many hospitals and group practices who want to promote connectivity by giving physicians electronic health records systems have not done so for fear that they or the physicians would be accused of violating federal anti-kickback or anti-self-referral rules.

David Brailer, MD, PhD, appointed by President Bush to coordinate the push for electronic health records, called the proposals "the most significant steps in our health information technology strategy to date."

"This easing of the anti-kickback regulations could be beneficial to smaller physician groups who want to reap the benefits of improved efficiency and reduced costs derived from electronic recordkeeping, but who cannot afford the capital investment necessary to procure it," Rutherford told Urology Times. "Of course, there are some trade-offs in terms of sharing control of patient data, but the alternative for many of these solo practices and small groups is to merge into larger groups that can obtain reasonable financing."

Plans should reach farther

Indeed, most of the groups who commented on the plans support them, but most don't think the plans go far enough.

For example, the American Medical Association noted that under the electronic prescribing portion of the rules, the list of acceptable donations includes hardware, software, Internet connectivity, training, and support services. AMA urges that the plan also include "maintenance, associated costs related to implementation, and upgrades, as well as any costs associated with licenses, rights of use, or intellectual property."

In addition, the association objects to HHS's plan to put a cap on the value of the items donated because the cost of future products is unknown. AMA says the problem is compounded by "the absence of any language in the proposed rules that accord physicians a choice with regard to the donated technology." That, says the group, could put physicians in the position of absorbing the extra cost of an offered package or rejecting it altogether.

AMA also protests that the rules would require physicians to certify the technology they already possess is not technically or functionally equivalent to any technology they would receive under the plan.

The association calls this rule a real burden. "Many physicians do not know the capabilities of the technology they possess or how their technology relates to the technology being offered by donors," the AMA said in a letter to CMS.

AMA also wants HHS to change the provision that would require donations for e-prescribing to be "used solely" for transmission of prescribing information, saying that could constrain software interoperability and hamper implementation of electronic health records and e-prescribing.

The American Hospital Association has told HHS that hospitals are not likely to take advantage of an e-prescribing-only exception, although the Medicare Modernization Act of 2003 mandated that narrow configuration. AHA noted that hospitals and physicians "need to exchange information across the spectrum of care."