In a recent Letter to the Vendor Community, David Blumenthal (National Coordinator for Health IT) warned about furthering a “digital divide” that can hamper healthcare providers who serve poor and minority communities.
Evidence of an emerging disparity in Electronic Health Record (EHR) adoption comes out of studies of hospitals. According to the 2009 study, “U.S. hospitals that provide care to large numbers of poor patients also had minimal use of EHRs. These same hospitals lagged others in quality performance as well, but those with EHR systems seemed to have eliminated the quality gap. These findings suggest that adopting EHRs should be a major policy goal of health reform measures targeting hospitals that serve large populations of poor patients.”
It seems reasonable to extrapolate from hospital-based data to the realm of ambulatory care, though there is not as much data there. Data from 2006 showed that the biggest driver of EHR adoption in office practices was practice size – small and safety net practices lag behind larger practices and clinics in their rate of EHR adoption. However there was only limited evidence of poorer IT access for physicians treating underserved patients.
Nevertheless, the ONC’s call for vendors to make sure that their products don’t worsen a “digital divide” is well heeded. In particular, small practices, safety-net practices and ambulatory care clinics that serve the underserved are sectors of healthcare delivery that need particular targeting in order to adopt EHRs. Largely because of expense, IT burden and workflow disruption of legacy EHRs (which rely on locally-installed server systems), these practices have had great difficulties embracing EHR technology.
If there is a large hospital that is able to purchase a system (assuming it is one that is appropriate for ambulatory usage), and offers it for free to its affiliated community physicians, then perhaps there is adoption in those settings. However, often the hospitals that serve such communities are the ones that are at the low end of EHR adoption rates. They often have much looser connection with their community physicians, leaving such physicians and clinics “on their own” when it comes to EHR adoption.
Web-based EHRs are emerging as the pathway to buck this trend. Our own experience with a low-cost (actually, it’s free) web-based ambulatory EHR has been dramatic uptake by physicians in all practice sizes – but especially among practices less than 5 physicians.
A particular program that Practice Fusion offers is the Practice Fusion Foundation, which helps bring sophisticated health IT systems to medical providers most in need. The EHR Assistance program partners with free clinics, non-profits and community health organizations to offer an ad-free version of the EHR to qualified non-profit organizations, along with specialized training, customizations, hardware guidance and implementation assistance.
We welcome the ONC’s call to the vendor community. It is fully in line with our outreach already. We have gathered significant experience in helping healthcare practitioners who deliver care in underserved and minority communities, and have accumulated a body experience in “what works.” Leveraging modern technology, and delivering the promise of EHRs (which are powerful tools in improving the quality of care) – these are advances that need to be available to all healthcare providers. We welcome everyone who helps move toward that future.
Robert Rowley MD
Chief Medical Officer
Practice Fusion EMR
