Rise of the e-mandates: Soon, you may not have a choice

As the drumbeat for use of health information technology grows louder, physicians are feeling pressure to buy in -- no matter what they think about its value.

By Dave Hansen, AMNews staff. Dec. 17, 2007.

North Shore Cardiovascular Associates in Salem, Mass., recently spent $280,000 for an electronic medical records system, or $20,000 for each of its 14 physicians. It figured it had no choice but to spend the money.

That's because Partners HealthCare, its hospital partner, mandated that North Shore, and every other practice that refers patients, have an EMR. Otherwise, they no longer can practice at Partners facilities. The hospital system has offered to pay some costs, but not all of them.

"It is basically a loss," said Mario Motta, MD, a cardiologist with the North Shore practice. "I don't get to keep the medical record if I decide to move. The benefit primarily accrues to the system and insurers, who make out royally for this. They should be paying for the bulk of it."

Some Partners-affiliated doctors are choosing to retire or leave rather than buy a system. Dr. Motta understands how they feel. "If I was in my mid-60s, I would say 'no way.' "

But more physicians soon may well be in the position of being forced to adopt some form of information technology.

Frustration with the slow spread of medical technology is driving some payers, hospitals and legislators to consider mandates to require physicians to purchase it.

The argument for mandates is one of patient safety and health system efficiency. Technology adoption by physicians is necessary to reduce errors and costs, advocates say.

With surveys showing fewer than 10% of doctors using electronic prescribing and only 20% using electronic medical records -- and those numbers stagnating -- too much is at stake to wait for doctors to adopt technology, say those advocating mandates.