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Physicians are eager to embrace the Internet’s transformation of health care but are cautious about the lack of uniform standards, a recent survey says. The survey, which polled physician leaders (medical directors and presidents) and office-based practicing physicians in medium and large practice organizations, found agreement that computers already have had a positive impact on the practice of medicine and quality of care. The survey was conducted by Rochester, NY-based Harris Interactive on behalf of the Health Technology Center (HealthTech) in San Francisco, in cooperation with PricewaterhouseCoopers in Los Angeles and the Institute for the Future in Menlo Park, CA.
The researchers surveyed physicians because they are on the front line but still carry most of the risk, says Lee Akay, senior partner for the PricewaterhouseCoopers MCS Healthcare Practice in Los Angeles and co-sponsor of the survey. "We wanted to understand their current situation about the Internet and what enabled it." The researchers also wanted to know how they could encourage use of Internet services among physicians.
More than a third of the physicians and practice leaders responding to the survey considered a wide range of Internet-enabled core business and clinical services to be essential to health care, with 96% of those surveyed agreeing that these technologies will make the practice of medicine easier and will improve quality of care before 2003.
The physicians identified six Internet-enabled services as "essential" for organizational success and found value in them because they reduce administrative costs, speed payments for care, and improve quality of care. The essential clinical applications were diagnostic reporting and electronic medical records (EMR). The essential administrative services include claims processing, eligibility authorizations, referral authorizations, and information technology systems support.
Some of the respondents were already using these technologies in their jobs. These applications include:
"Physicians are actively seeking to integrate computers and the Internet into their practices and do not appear to need further convincing that technology will play an increasingly significant role," says Molly Joel Coye, MD, MPH, HealthTech CEO.
Although physicians see the potential in Internet-enabled services, they are cautious about implementing them. For example, only 7% of the survey respondents have adopted automated prescription systems, despite the Institute of Medicine’s 1999 patient safety report recommendation.
What is holding them back? The physician leaders in the survey overwhelmingly agreed (93%) that "lack of system compatibility across health care organizations" is a critical barrier to realization of the full potential of Internet-enabled systems in medicine. This concern about standards ranked much higher than concern about confidentiality and privacy, which ranked only sixth among the concerns. About half of the respondents rated privacy as a minor concern.
Most respondents (93%) said industrywide agreement on standards would be an effective way to drive change in the health care industry. Eighty-four percent said this was the preferred way to bring about universal use of the Internet.
When asked who might step in to fulfill the needed integration and standard-setting, more than two-thirds of the respondents said the most effective action would be steps taken by the Health Care Financing Administration (HCFA) in Baltimore or steps taken by major health plans to require participating physicians to use the Internet for claims processing. The physicians saw little value in creating a nonprofit government-sponsored program to handle these issues.
"These results suggest that HCFA could improve the coordination of patient care and reduce health care costs by supporting providers in their movement onto the Internet and by making Internet filing a requirement," Coye says.
"Health plans can learn [from this survey] that physicians are willing to work with them to develop standards, help design some of the benefits, and at the same time get their portion of the health care dollars," Akay adds.
Only 59% of the responding physicians said increased payment for claims filed over the Internet would be sufficient to cause rapid, widespread change, she says. Akay finds this result to be one of the most surprising in the survey. "You would think that if you increased the capitation rate or if you added some type of fee to Internet usage, Web-enabled services or Internet usage would increase," Akay says. "The physicians, however, were more interested in standards throughout the organization, led by either HCFA on the government side or large plans."
Standards set by the Health Insurance Portability and Accountability Act of 1996 could be a conduit for accelerated adoption of industrywide standards, Akay says. "The fundamental key to success is how quickly and how well those standards are implemented."
He also sees a challenge not only in establishing standards throughout the industry but also in figuring out how to share the efficiencies that are created by Web-enabled technology. "One group shouldn’t get all of the benefit. Finding a way to share those efficiencies [among hospitals, physicians, and health plans] will be key."
The survey was conducted from Nov. 29, 2000, through Jan. 10, 2001, with a total of 215 practicing physicians and physician leaders of medical practice organizations with at least 25 physicians. The surveys were completed on-line using random samples of physician practices drawn from the American Medical Association Group Practice File and the Physicians List.
The survey data was weighted to reflect the composition of the Practice File and the Physicians List with regard to the following variables: group practice size, region, and medical specialty (for practicing physicians only).