In the past, mentioning electronic health records (EHRs) to pharma industry marketing departments would mostly elicit, if
anything, yawns and conversation-stoppers. They're too costly to install and maintain, and therefore most physician practices
aren't using them. In 2008, when the Journal of the American Medical Informatics Association (JAMIA) published a case study from Pfizer's healthcare informatics group, which examined how EHRs might support business
functions, the primary conclusions were that EHRs could potentially be valuable in some areas, such as drug safety and surveillance
or clinical trial recruitment. The assumption was that EHRs could provide patient data and contribute to a more robust database
for drug monitoring, but again, without widespread physician adoption, the benefits of EHRs for pharma seemed limited.
Then, in 2009, the Obama Administration earmarked a whopping $19.2 billion for EHRs as part of the American Recovery and Reinvestment
Act (ARRA), and put new incentives in place for adoption; the Congressional Budget Office (CBO) estimates that healthcare
information technology (HCIT) spending could top $36 billion. Under the well-known "meaningful use" provision of the ARRA,
sticks have now emerged, in addition to the carrots, for EHR adoption and e-prescribing. Physician practices stand to receive
up to $44,000 per physician over a five-year period if they adopt EHRs in 2011, direct from the Centers for Medicare & Medicaid
Services (CMS). Penalties for non-adoption begin in 2015. Some physicians jumped on board soon after the incentive program
was announced, but the vast majority did not. In 2009, approximately 153,000 physicians were using EHRs in their practice,
and in 2010, that number increased to 171,000. Beginning this year, however, adoption rates are expected to grow exponentially,
with 254,000 physicians using EHRs in 2011, and 376,000 in 2012. By 2013, roughly 70 percent of physicians, or 557,000, are
expected to be using EHRs. The CBO predicts that 80 percent, or 726,000 physicians, will be using EHRs by 2019.
While the biggest providers of EHRs, such as Epic, Allscipts/Eclipsys, and NextGen, are well established, and medium-size
players such as Cerner, Sage, Greenway, and AthenaHealth have made headway with early adopters, there haven't been, until
recently, EHR providers that offer a clear way in for pharma.
"With the exception of Practice Fusion"—a free, ad-supported EHR provider—"there are no real pharma regulatory or marketing
services available in electronic health records," says Ed Fotsch, CEO at PDR, publisher of the Physicians' Desk Reference,
a drug reference service. "EHRs were developed ignoring the pharmaceutical industry." As sales forces shrink, and direct access
to physicians becomes increasingly difficult, Fotsch says there's a need for the provision of basic services that physicians
and pharmaceutical companies find valuable. "Whether you have a pharma regulatory goal or a marketing goal, either one requires
engagement with physicians, ideally at the point of care," he says. To that end, a new crop of EHR providers such as Practice
Fusion, PDR, and, most recently, Epocrates, are stepping up to the plate, in an attempt to give pharma marketers access to
physicians, without disrupting their workflow. Fotsch, a physician, says "the traditional goal of pharma, when I was practicing,
was to disrupt my workflow with pizzas, coupons, great-looking drug reps, and so on, and while that was pleasant, it didn't
exactly help my patient volume throughput."
EHR Adoption Projections in the U.S.
Other parties, besides EHR providers, have recognized the value of EHRs. Hospitals are now actively purchasing EHR platforms
for physician practices, assuming that a systems alignment between a physician group and a hospital will boost referrals—a
safe bet, according to Fotsch. "If the EHR platforms are in sync, and really accessible, between a physician's office and
the hospital, so that dictations, lab results, and so on can be freely exchanged, [the physician] is much more likely to refer
to that hospital," he says. Hospitals such as Advocate in Chicago, Sisters of Charity of Health System in Cleveland, Long
Island Jewish Medical Center in New York, and others have committed "tens of millions of dollars" to bolstering referral lines
through EHR purchases, says Fotsch. Asked whether pharmaceutical companies could see a positive ROI on purchasing EHRs for
doctors, Fotsch says part of the reason that pharma has been left out of EHR design to date is that pharma "can't legally
give away EHRs; that would be a broad inurement issue."