"Without adequate financial incentives, small practices and their patients will be left behind the technological curve," said Yul D. Ejnes, MD, a member of the Board of Regents of the American College of Physicians and chairman of ACP's Medical Service Committee. Ejnes testified at a hearing of the House Ways and Means Committee's Subcommittee on Health.

Ejnes acknowledged that the benefits of widespread adoption of interoperable healthcare information technology would be significant, leading to a higher standard of quality in the U.S. healthcare system. But he noted that much of the savings from physician investment in healthcare IT are realized by public and private payers, not doctors themselves.

"Acquisition costs can average up to $44,000 per physician (and) the average annual ongoing costs are about $8,500 per physician," said Ejnes."For many of these practices, the 'business case' for making such a large investment simply doesn't exist."

Ejnes, a general internist in private practice in Cranston, R.I. , told the subcommittee his 50-physician group practice has an electronic health record system, but has received some support from a "forward-looking" private payer.

"With these favorable factors, you would think our decision to implement an EHR was simple," said Ejnes."On the contrary, it took us 10 years. We have been using our EHR for two years now and have found that the challenges associated - especially the cost and impact on workflow and the lack of true interoperability - to be very substantial

Yet our challenges are not nearly as great as they are for physicians in smaller practices."

Ejnes revealed that, of ACP members involved in direct patient care, approximately 20 percent are in solo practice and 50 percent are in practices of five or fewer physicians.

"Three-fourths of all Medicare recipients receive their outpatient care from smaller physician practices," said Ejnes."These are the physicians who already lag in HIT adoption and are least likely to have the necessary capital on hand to invest in technology."

The ACP presented specific recommendations to Congress that are intended to help physicians adopt and use healthcare IT. They include:

• Build into the Medicare physician payment system an add-on code for office visits and other services when supported by certified healthcare IT.
• Continue to support the establishment of the standards needed to allow true interoperability.
• Continue to advance the Patient Centered Medical Home, or PCMH, model as a means of rapidly driving primary care practices to acquire the information systems and other capabilities needed to provide patient-centered and coordinated care.
• Require that Medicare cover specific services associated with patient-centered care, such as secure email consultations and remote monitoring.

The American College of Physicians represents 126,000 internal medicine physicians, related subspecialists and medical students.