A recent study in the Annals of Family Medicine concludes that “without continued financial and operational support, physician practices with limited resources — especially those in rural areas — will be unable to keep up with meaningful use requirements in future phases of the EHR Incentive Programs

“Our findings suggest that, without ongoing support addressing the themes identified above, low-resource practices may achieve Stage 1 meaningful use only to fall by the wayside, resulting in an ever-widening “digital divide” as better-resourced practices continue to increase the sophistication of their health IT operations,” write Green et al.

The study identify four areas where meaningful use sustainability could overwhelm these low-resource facilities.

  1. The first is the availability of managerial, organization and change management expertise which many of these practices relied on regional extension centers (RECs) to provide at little to no cost for Stage 1 Meaningful Use.

    “Low-resource practices benefitted substantially from direct assistance in change management, business process planning, and other professional managerial issues,” the authors explain. “These practices typically did not have the scale or resources to support a trained professional manager and could not afford to engage management consultants.”

  2. The second area concerned the technology support required to maintain hardware and software related to certified EHR technology.

    As Green et al. observe, physician practices with limited resources generally lack “the internal skills to select optimal replacement or upgraded hardware, to train staff beyond the brief instruction offered by vendors in the use of new versions of their EHRs or when new staff join, or to maintain system and network security as new threats emerge.”

  3. Although the support of the RECs gave low-resource practices advantages in their dealings with health IT vendors, that leverage is found wanting as these facilities move forward with meaningful use (and more complex meaningful use requirements) and the funding for these external resources comes to an end.

    “Stage 2 meaningful use will require much more sophisticated use of health IT, well beyond what they were trained to do in implementation, but low-resource practices are not able to purchase additional training time,” Green et al. argue.

  4. Rural practices face challenges unique to their location that place them at a serious disadvantage:

    They often had unreliable Internet service, for example, resulting in a greater need for hardware consultants, but in many rural areas skilled hardware consultant services simply do not exist. Similarly, while both urban and rural practices struggled to pay for software, security, and training consultation, rural practices often found such services nonexistent in their areas.

According to the authors, two solutions could help low-resource practices. The first is the continuation of the REC program or a similar setup. The other is federal support, but this would be limited to designated FQHCs and community health centered.

Barring either one of these interventions, the outlook for smaller physician practices with limited resources is bleak for both meaningful use and long-term viability.

“Ultimately, any long-term stable solutions must address the operational and financial needs of low-resource primary care practices in general, and the additional needs of rural practices in particular. Absent that, the multifaceted challenge of health IT maintenance will almost inevitably overwhelm low-resource practices,” the authors conclude.