Washington, D.C. -- The Internet is transforming medical practice for physicians far more rapidly than most industry observers thought possible, according to a recent survey conducted for the Health Technology Center (HealthTech) by Harris Interactive in cooperation with PricewaterhouseCoopers and the Institute for the Future (IFTF). The survey, which polled physician leaders and office-based practicing physicians in medium and large practice organizations, found widespread agreement that computers have already had a positive impact on the practice of medicine and quality of care.

More than a third of the physicians and practice leaders consider a wide range of Internet-enabled core business and clinical services to be essential advantages, with 96% of those surveyed agreeing that these technologies will make the practice of medicine easier and improve quality of care no later than 2003. Physicians identified six Internet-enabled services as "essential" for future success and found value in them because they reduce administrative costs, speed payments for care, and improve quality of care. The survey also found that 34% of surveyed physicians and practice leaders use Internet-enabled sources for information about prescription medications.

Despite the Institute of Medicine's (IOM) 1999 patient safety report recommendation that physicians adopt automated systems for prescribing, only 7% of the survey respondents have done so. Physicians and practice leaders concurred that the greatest barriers to universal implementation of Internet-enabled services are a lack of uniform standards for health information and the inability of current health information applications to communicate among themselves. Physicians from the reporting organizations believe that action by the Health Care Financing Administration (HCFA) or by the major health plans that would require participating physicians to use the Internet for administrative services such as claims processing will be needed to cause rapid migration to Internet-enabled services.

Approaching the Tipping Point

"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," said HealthTech CEO Molly Joel Coye, MD, MPH. Looking beyond the use of the net for their own news-gathering and research activities, the applications that respondents indicated had the greatest use include:

¥ Diagnostic reporting (34%)
¥ Claims processing services (35%)
¥ Pharmaceutical information (34%)
¥ Purchase of medical office products (29%)
¥ E-mail communication with patients (29%)
¥ Electronic medical records (19% indicated they are testing or have fully implemented EMR)

When asked about the services they considered critical for organizational success, physicians identified six "essential" Internet applications, including a mix of administrative and clinical functions. The essential clinical applications were diagnostic reporting and electronic medical records. The essential administrative services included claims processing, eligibility authorizations, referral authorizations, and IT systems support.

Lee Akay, Managing Partner for the PricewaterhouseCoopers MCS Healthcare Practice and co-sponsor of the survey, called attention to the unique study sample that identified physician leaders (CEOs or Medical Directors of medical groups) within a broader sample of physicians practicing in medical groups. "Physicians are increasingly moving into medical groups that have the organizational capacity to assess and invest in new technologies. By focusing on physicians practicing in a group setting, this study more accurately benchmarks trends in medical practice. These organized physician practices are moving the industry as a whole toward the "tipping point" in adopting new technology. This demonstrates that physician leaders clearly comprehend the tangible benefits of linked networks and shared data."

Physician leaders cited the lack of data and communication standards and "real world" applications designed to fit existing workflow patterns in clinical settings as significant factors slowing the uptake of technology. Other barriers included the lack of capital and individual resistance to change. According to Akay, "Current systems frustrate both patients and physicians with complex paperwork and medical records that are frequently lost or incomplete. Physicians are stymied by incompatible systems that cannot "talk" to each other, and most of all by the absence of industry standards that would allow vendors to develop applications that link data from disparate systems. The absence of standardized and compatible services across the industry makes it risky for individual practices to move to the next level of Internet-enabled efficiencies and quality improvement."

Clearing the Hurdles

Physician leaders overwhelmingly agreed (93%) that "lack of system compatibility across healthcare organizations" is a critical barrier to realization of the full potential of Internet-enabled systems in medicine. Surprisingly, concern about confidentiality and privacy ranked sixth among the concerns, with about half of the respondents rating privacy as only a minor concern.

On the question of who might step in to fulfill the needed integration and standard-setting, more than two thirds of respondents believe that the most effective action would be steps by the Health Care Financing Administration (HCFA) (72%) or major health plans (68%) to require participating physicians to use the Internet for claims processing. Only 59% of the responding physicians felt that increased payment for claims filed via the Internet would be sufficient to cause rapid, broad-scale change. Coye said, "These results should provide encouragement to regulators and health plans alike that the physician community is prepared to respond affirmatively to well-executed and coordinated plans for widespread Internet-based healthcare transactions. HCFA is the largest purchaser of healthcare in the country. These results suggest that HCFA could improve the coordination of patient care and reduce healthcare costs by supporting providers in their movement onto the Internet and by making Internet filing a requirement."

Elaborating on the theme of standards, 93% of physicians and physician leaders cite industry-wide agreement on standards as an effective way to drive change and 84% of respondents said it was the "preferred" way to bring about universal use of the Internet. Physicians would like either industry associations or health plans to assume the lead role in vetting a standardized suite of Internet-enabled services and saw little value in creating a non-profit, government sponsored organization to sort out these issues. Akay noted, "Recently enacted Health Insurance Portability and Accountability Act (HIPAA) legislation, which, among other things, sets standards regarding how providers communicate with the Medicare program, could be a conduit for accelerated adoption of industry wide standards. The fundamental key to success is how quickly and how well those standards are implemented."

Wendy Everett, the director of IFTF's healthcare programs and chair of the HealthTech board, sounded a note of urgency, "This study should serve as a wake-up call for all physicians who are not yet prepared to take advantage of Internet-enabled clinical and administrative services. These results show that Internet-enabled medical practice is rapidly approaching critical mass and medical providers who don't have these capabilities will soon be at a real disadvantage."

Copies of the Survey Toplines and Chartpack are available online at www.healthtechcenter.org  or by calling HealthTech at (650) 233-9576.

Methodology

The survey, "Internet Use by Medical Groups" was conducted by Harris Interactive on behalf of the Health Technology Center (HealthTech) in cooperation with PricewaterhouseCoopers and the Institute for the Future. The survey was conducted from November 29, 2000 through January 10, 2001 with a total of 215 practicing physicians and physician leaders of medical practice organizations with at least twenty-five physicians. The surveys were completed online using random samples of physicians and practice leaders (medical directors and presidents) of physician practices drawn from the American Medical Association Group Practice File and the Physicians List.

The survey data were weighted to reflect the composition of the American Medical Association Group Practice File and the Physicians List to the following variables: group practice size, region, and for practicing physicians only, medical specialty.

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