Digital divide plagues slow e-health records rollout

EHRs can sometimes be the difference between life and death

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"They tend to have no IT infrastructure. They tend to be undercapitalized. They tend to not have the percentage of insurance-based patients, the so-called 'Cadillac plans,'" Le Clair said. "Basically, they're dealing with the 38 [million] to 40 million of uninsured Americans."

Under a SaaS model, EHR applications such as physician-order-entry systems are hosted on servers in a vendor facility and hospitals would access those systems through a secure Internet portal or via a virtual private network. That way, the health care facility would not need to deploy hardware and software in its data center or hire the IT staffers needed to support and maintain an EHR system.

Le Clair said that even large, highly-profitable hospitals today are struggling with EHR adoption because they face other challenges. For example, health care facilities face a 2013 deadline to implement the ICD-10 standard, a diagnostic coding system used for insurance processing and reimbursement and gathering statistical data.

"My solution is to take the SaaS offerings coming to market, many of which are from start-up companies that need help, and select a few of those and invest in them so they can have lower-cost services for these areas," he said. "That's short money for the efficiency that will accrue to the administrative costs."

Among the EHR service providers Le Clair cited are large companies like Allscripts, with its EMR Workforce offering; McKesson, which has a system called Horizon Practice Plus; and Sage, which offers Intergy OnDemand. He also cited smaller companies like eClinicalWorks and Greenway Medical Technologies.

Prices vary by vendor, but basic SaaS-based EHR offerings -- hosted by the vendor in a data center -- cost around $350 a month.

Federal help for EHRs

HHS has spent $62 million on the creation of 62 regional extension centers (REC) throughout the country. Their mission is to help rural medical facilities roll out EHRs.

The federal government also issued $144 million in grants to create college courses to train people and help fill an estimated 50,000 jobs needed to assist doctors and hospitals as they roll out EHRs. However, none of the government money covers the cost of EHR hardware and software -- the most basic costs associated with health IT.

Dr. Garth Graham, deputy assistant secretary for Minority Health in the Office of Minority Health at HHS, said the government is looking at "a number of different models" for improving infrastructure at community health centers. For one, HHS formed the National Health Information Technology Collaborative for the Underserved, which aims to help rural and nonprofit facilities figure out how to deploy EHRs.

But Graham said his office is just now getting "abreast of the landscape" and investigating different models for deploying EHRs.

"There's no simplifying it," Graham said. "There are certainly a number of challenges, from cost to physician behavior and doctors' attitudes toward EHRs.

"You've got to reach folks and educate them in terms of the different strategies they can move forward," he added. "It's not going to be easy. Certainly we know that providers who take care of rural and underserved community face many challenges."

Lucas Mearian covers storage, disaster recovery and business continuity, financial services infrastructure and health care IT for Computerworld. Follow Lucas on Twitter at @lucasmearian, or subscribe to Lucas's RSS feed . His e-mail address is

Copyright © 2010 IDG Communications, Inc.

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