Electronic records push: Big companies tell physicians they better go tech

A coalition starting with five big employers believes it can lead physicians to technological waters and make them drink.

Wal-Mart Stores, Intel, BP America, Pitney Bowes and Applied Materials are launching an initiative under which they will invest at least $5 million to give electronic portable personal health records to employees through a Web-based framework called Dossia. Other employers are being invited to join the coalition, which launches its service in mid-2007.

Medical costs are rising faster than inflation, and it's affecting employers' competitiveness because they pay half the cost of the total health insurance in the country, Intel Chair Craig Barrett said during a Dec. 6 news conference in Washington, D.C. "We want to get a more effective return on that investment" and help employees better manage their care, he said.

Barrett said the employers don't intend to penalize doctors who don't access and update workers' PHRs. In a phone interview with AMNews after the news conference, Barrett said he believed that employees would be the ones demanding that physicians take their PHRs. But he said employers might "lean" on physicians, though he didn't specify how.

"The consumer is going to demand best practices, the consumer is going to want to have the data, the consumer is probably going to drive [doctors and other health care professionals] more than employers," Barrett said. The employer coalition views its Dossia PHR initiative as a way to empower consumers, he said.

But some industry observers think that it is an early sign that employers eventually are moving toward bluntly telling doctors that if they don't use information technology, employees will be discouraged from seeing them. That message eventually could include other technologies, said David Edman, managing partner of Risk Management Partners LLC, a health care consulting firm in Wayne, Pa.

"Other things that they are looking for are doctors who are using EMRs, electronic prescription writers, even something like using the Internet for communication with patients," Edman said. "Why does the patient or the employer have to pay for an office visit if all the patient wants to do is ask what to do about [a simple problem]?

"It's a process of defining high-performance provider networks -- we don't want everybody. We don't want all doctors and hospitals. We want high-performance providers."

At the news conference, members of the coalition answered several questions, but they did not address whether they eventually will insist that clinicians adopt electronic records and prescribe electronically as a condition of business, as was reported in a Wall Street Journal story Nov. 29. The newspaper also reported that the employers expected workers to see doctors who would use and update their PHRs, possibly squeezing out doctors who wouldn't participate.

The companies did say the record would be owned by employees, not by employers or insurers. Dossia is operated by a Portland, Ore.-based nonprofit called the Omnimedix Institute.

Others could be interested

Observers expect that other employers will be watching the initiative very closely. For it to succeed, the employer initiative will need to overcome a number of challenges, including privacy and security concerns, lack of standardized format for a PHR and what information it should contain, they said.

But to succeed, the firms also need physicians to believe that they will lose a good chunk of their patient base if they don't adapt their practices. Some analysts say the companies, despite their size, right now just don't have the juice to make that happen.

"It's not like we're dealing with a [physician] market that's yearning for additional customer loads," said Jay Savan, a principal in Towers Perrin, a benefits consultancy.

"They would just as soon say, 'Hey, we can make as much money as we are making today if X percent of our customers went away because we're basically understaffed and over capacity.' So how are you going to now impose additional requirements on that system and say, 'We're not going to pay you unless you play with us?' They certainly have as much business as they can handle in many respects."

Savan said there is another reason that employers also lack leverage. If patients have a good relationship with their physicians, many of them won't dump their doctors over updating their PHRs.

Unlike a paper-based or electronic medical record that doctors create and store in their offices, a PHR is created, owned and maintained by patients. Several companies offer PHR products to consumers. Some charge a fee while others, including payers and Medem, which is partly owned by the AMA, give it to consumers for free.

Most PHRs, including Dossia, are Internet-based. Doctors don't need an EMR to enter information in a patient's PHR, just a computer, an Internet connection and their patients' permission. Dossia, like other PHRs, does not allow patients to change doctor-entered information.

The American Medical Association and others in organized medicine are generally supportive of EMR and PHR adoption. But they do not support mandates on doctors to do so. The Dossia initiative as of yet contains no mandates for employees to see physicians who will accept and update PHRs.

"We ... think it's important that patients have the ability to seek the doctors and the care that's best for them," said AMA Trustee Robert M. Wah, MD, a reproductive endocrinologist and ob-gyn in McLean, Va. "So we want to make sure whatever plan they end up implementing maintains that freedom and [patients'] right to choose the best possible doctor and care for them."