Either they’re solidly in line and in step with the clinical need for EHR, offering heartfelt acceptance regardless of the costs or they seriously question the total costs involved, the disruptive nature of the technology and the clinical benefits, which may be overstated, hard to quantify and anecdotal at best.

Many physicians, however, fall somewhere in between, watching policy developments within the federal government unfold, as well as product developments among the supplier community debut. While President Bush’s announcement nearly four years ago supporting a national electronic health record to be operational by 2014 initially may have lit a fuse in the healthcare industry, the fervor has settled to a steady gait.

Regardless of the rollercoaster ride today, McKesson Corp. targeted software as a tentpole business operation as far back as almost a decade ago when it made headlines in 1998 by acquiring HBO & Co. Until then, the pharmaceutical distributor had been expanding its reach into the medical/surgical supply arena, acquiring a number of smaller competitors to become a pre-eminent "box mover." The HBOC addition represented a turning point for McKesson in the pre-Internet-based electronic commerce era.

Since that initial foray into information technology, McKesson has further demonstrated its serious commitment to software. Last year it divested much of the med/surg business it accumulated to Owens & Minor, saving the physician-oriented operations. Within the last few months, McKesson acquired two physician-related software companies that offer EHR products – Per Se Technologies and Physician Micro Systems, which also is known as Practice Partner. McKesson’s tactics send a clear message where the company is heading and how it envisions EHR’s future, even as it develops strategies to convince physicians its vision is on the verge of reality.

To that end, Healthcare Purchasing News reached out to Tom Leonard, vice president and general manager of Ambulatory Solutions for McKesson Provider Technologies, to share his insights on how rocky the road ahead to EHR really is. Leonard is responsible for overseeing operations and overall strategic and product direction and sales and marketing objectives for three business units: Physician Office Solutions, Extended Care Solutions and Revenue Cycle Outsourcing.

Prior to joining McKesson, he was executive vice president of operations for Picis Inc. a leading provider of ED, OR, anesthesia and critical care information solutions. While at Picis, Leonard also headed up corporate development and customer management. Before his tenure at McKesson and Picis, Leonard served as vice president of operations for MediTrader Inc., an Internet e-commerce company serving the healthcare industry. He also has experience in technology and operations consulting.

Leonard began his career as an officer in the U.S. Navy, receiving both individual and unit commendations during his military service in support of Operation Desert Storm, as well as military operations in Bosnia-Herzegovina, Somalia and Haiti.

LEONARD: The patient ultimately has the most to gain from pervasive use of the EHR. As an example, imagine the impact on patient safety and the reduction in adverse drug events when primary care physicians, specialists, emergency care physicians and other care givers have access to a patient’s complete medication list. When the vision of the connected clinical community is realized, providers will have the ability to collaborate on patient care and receive real-time decision support. These advancements will not only increase care quality but will also take wasted money and inefficiencies out of the healthcare system. The logical result – better care at lower cost.

The trend is clearly towards adoption. The question is really around the rate of adoption. We don’t talk to any hospitals or physicians that say they don’t want to adopt an EHR. However, in the absence of funding, some will get to it slower than others. Those providers with access to capital in competitive markets will move first.

The key reason physicians have not adopted EMR solutions to date is directly related to the total cost of ownership – the acquisition, ongoing support, hardware and human resource costs. The prevailing opinion of the current administration is that the government should not subsidize IT acquisition as it should be considered part of the cost of doing business. Looking to the government for subsidies is not something we see on the horizon.

McKesson has been very aggressive pushing for Stark relaxation and Anti-trust safe harbors because we believe that’s an appropriate way to drive incentives for EHR acquisition that results in a win-win for physicians and hospitals.

We also believe that reimbursement reform and pay-for-performance programs will begin to drive incentives for the use of technology – not incentives to acquire technology. In conjunction with reimbursement reform, we would also support proposals for tax credits and interest-free loans to support physician acquisition and implementation of an ambulatory EHR.

The bottom line is historically the entry barriers were higher than they are today. Both the cost and risk were significant for providers. Now with Stark relaxation, CCHIT Certification and more affordable price points, physicians can be much more comfortable with their technology decisions.

We don’t believe a mandate will be necessary. We would always prefer to think that physicians will be rewarded for adoption, but it is not unthinkable that the financial implications could drive adoption from the other direction.

The goal of the survey was to explore physician attitudes toward working with local hospitals to deploy EHRs in support of a goal set by President Bush for the majority of Americans to have EHRs by 2014. There is a tremendous opportunity for physicians and hospitals to collaborate in the interest of higher-quality, safer healthcare. Physicians want to focus on practicing medicine, not on maintaining complex healthcare IT systems.

Hospitals have a strong track record for making significant investments in technology. Moreover, they have a strong track record of in-house IT expertise. They have both the expertise and capability of connecting local physicians with one another, payers, patients and other providers.

Physicians ranked clinical benefits of EHRs higher than financial factors. Eighty percent of respondents ranked ‘coordination of care across care settings’ as the No. 1 benefit of a hospital-sponsored EHR, while 52 percent indicated that the system will save their practice money in the long run. The research also shows that when physicians are considering an EHR system for their practice, the number one consideration is support and technical assistance followed closely by price.

Among the survey’s other notable findings was the validation by physicians that hospitals already provide a number of valued electronic services including the ability to view discharge summaries, hospital charts, laboratory results and medical images in a seamless manner. As a result, physicians indicated that they prefer to partner with a local hospital for EHR technology and that they are willing to pay a fee in return for access to technology systems.

We have relied on definitions from the [Institute of Medicine] and other industry influencers. At a very high level: An electronic medical record is created within a physician practice through the use of technology that might include encounter documentation, prescribing and order management. The information is intended for the use of that practice and is not easily shared with other providers. An electronic health record is more comprehensive contiguous care record and includes patient information from a variety of sources across care settings. We define the electronic patient record as the personal health record (PHR.) The PHR is a patient’s electronic collection of their health information that they might choose to share with a provider.