Fostering Health Information Technology in Small Physician Practices: Lessons from Independent Practice Associations

Originally published by the Center for Studying Health System Change (HSC) as NIHCR Research Brief No. 5, June 2011.

Supporting Health IT Adoption in Small Physician Practices

As federal policy makers work to accelerate adoption of health information technology (HIT) in physician practices, small practices have consistently lagged behind their larger counterparts. Limited technical expertise and insufficient financial resources are primary obstacles for small practices seeking to implement electronic health records (EHRs) and other health IT tools. While broader trends show physicians gravitating toward larger practice settings, a substantial share of the physician workforce is expected to remain in small group practices for the foreseeable future, making their technology adoption an ongoing policy concern.

A qualitative study by the Center for Studying Health System Change (HSC), authored by Timothy K. Lake, Tricia Collins Higgins, and Paul B. Ginsburg, examined how independent practice associations (IPAs) have helped their member practices overcome barriers to health IT adoption. IPAs are networks of small, independent medical practices that originally formed in the 1970s to allow these practices to accept risk-based managed care contracts. The study found that IPAs offer a useful model for understanding how network-based organizations can support HIT activities among practices that would otherwise lack the resources to adopt technology on their own.

How IPAs Facilitate Technology Adoption

The five IPAs examined in the study provided coordinated assistance with health IT activities to their member practices in several ways. They offered centralized technical support, helping practices select, implement, and maintain EHR systems. They negotiated volume discounts with technology vendors, reducing the per-practice cost of acquiring software and hardware. They provided training resources and ongoing troubleshooting assistance that individual small practices would have difficulty affording or staffing on their own.

Perhaps most importantly, the IPAs cultivated trusted physician leaders with health IT expertise who could serve as advocates and mentors for less technologically savvy clinicians. Peer influence proved particularly effective in overcoming physician resistance to new technology. When respected colleagues within the network could demonstrate the practical benefits of EHR adoption and share strategies for integrating technology into clinical workflow, other physicians were more willing to follow.

Aligning HIT with Quality Improvement and Payment Reform

The IPAs studied also provided leadership in connecting health IT adoption to other organizational priorities, particularly quality improvement and pay-for-performance programs. Rather than treating technology adoption as a standalone goal, successful IPAs framed it as a means to achieve better patient outcomes and financial performance. This alignment gave physicians a clearer rationale for investing time and energy in learning new systems, because the technology was directly tied to activities that affected both their clinical practice and their compensation.

This finding carries broader implications. As the health care system moves toward value-based payment models that reward quality and efficiency, the ability of small practices to collect, report, and act on clinical data will become increasingly important. IPAs that had already built the infrastructure to support HIT adoption were better positioned to help their member practices participate in emerging payment reform programs, including accountable care organizations and patient-centered medical home initiatives.

Lessons for Regional Extension Centers and Other Support Entities

The IPA experience offers practical lessons for Regional Extension Centers (RECs) and other organizations established under federal programs to help small practices adopt EHRs and achieve meaningful use. The study highlights the value of trusted relationships between support organizations and the practices they serve. IPAs had built these relationships over years of working together on managed care contracts and quality improvement, giving them credibility that a newly established support entity might take time to develop.

The study also raises a cautionary note about the growing number of entities involved in fostering health IT adoption. With multiple organizations potentially offering overlapping assistance to the same practices, including RECs, health information exchanges, quality improvement organizations, and professional associations, the potential for duplication and confusion increases. Effective local planning, open communication among stakeholders, and ongoing assessment of how best to coordinate these efforts are important to ensure that limited resources are used efficiently and that practices are not overwhelmed by competing demands from multiple support programs.

Sources and Further Reading

Lake, Timothy K., Tricia Collins Higgins, and Paul B. Ginsburg, "Fostering Health Information Technology in Small Physician Practices: Lessons from Independent Practice Associations," NIHCR Research Brief No. 5, Center for Studying Health System Change (June 2011).

DesRoches, Catherine M., et al., "Electronic Health Records in Ambulatory Care: A National Survey of Physicians," New England Journal of Medicine, Vol. 359, No. 1 (July 2008).

Office of the National Coordinator for Health Information Technology, resources on Regional Extension Centers and the EHR Incentive Programs.