No Provider Left Behind

On June 28th, Nicole Lewis of InformationWeek reported that as the push to implement new health information technology (HIT) among healthcare providers continues, many small physician practices offering services to low income patients have shown a reluctance to adopt HIT, such as electronic health records (EHRs). If these medical practices continue to resist implementing modern HIT systems, the situation threatens to widen healthcare disparities in the coming years, said Dianne Hasselman, director of quality and equality at the Center for Health Care Strategies (CHCS), at a recent public hearing on how technology can improve healthcare delivery among low-income populations. Hasselman's work with CHCS, a Hamilton, N.J.-based nonprofit health policy resource center dedicated to improving healthcare quality for low-income children and adults led her to meet with solo practitioners in Oklahoma City, Detroit, and Philadelphia. She noted that while these physicians truly want to improve care for their communities, they are extremely reluctant to adopt HIT. Many small practices don’t have computers and are struggling to provide basic healthcare services. Doctors at these practices are saying, "hey, don't even talk to me about HIT now. Help me with practice management, help me just to keep my shingle out, and then I can take a breath and get some breathing space and focus more on HIT or quality improvement," Hasselman said. While these practices are small, they serve a large swath of the population, including large clusters of patients with diverse ethnic and racial backgrounds. For example, Michigan’s Medicaid data shows that approximately 50% of beneficiaries in Detroit receive care in practices of three or fewer providers. This scenario is true across many cities and regions in the US.
The problems these providers face are further compounded when you consider the very real possibility that the longer these providers remain “off the grid” while other larger group practices and health networks are coming online, these offline providers will be increasingly marginalized from emerging electronic pharmaceutical, quality assurance and decision support and patient education systems. Inevitably this will limit the ability of these providers to provide the emerging standard of care for their patients. If that was not bad enough, this may in turn, subject these providers and the hospitals where they have privileges to increased litigation due to the provision of “substandard care”. All of this will potentially be occurring just around the time that 30 million more consumers are entering the healthcare system. America...We have a problem! It is not only how we pay for healthcare but also how do we as a nation, guarantee that we can provide necessary care to those that need it. If the majority of safety net providers leave the system and their patients are forced to seek care other places, it becomes alarmingly possible to develop a scenario, which could be repeated at many centers around the country, where the local healthcare system is stretched beyond capacity and therefore not able to offer good care to anyone. If this is not a call to action for our nation to address healthcare disparities, then I don’t know what is.