An Oakland-based nonprofit designated by the federal government to help doctors adopt electronic health records technology and qualify for substantial federal subsidies, plans to start enrolling doctors by the end of May. If physicians can prove they have effectively implemented an EHR system, they can collect up to $65,000 in federal incentives.

California Health Information Partnership & Services Organization (CalHIPSO) is an Oakland-based nonprofit, one of two California entities which has been allocated a total of $31 million by the U.S. Department of Health and Human Services for helping primary care doctors and other health providers purchase and use technology for electronic health records. CalHIPSO is designated to get $17.3 million of that. CalHIPSO is a not-for-profit joint venture between the Califonria Primary Care Association, the CMA and the California Association of Public Hospitals and Health Systems. It has a federal designation as a regional extension center and serves all of California except Los Angeles and Orange counties.

CalHIPSO intends to contract with local extension centers (LECs), preferably nonprofits, which will provide technical service to doctors and healthcare providers. Those services will include helping doctors to identify the technology they will need, helping them select a vendor, providing a group purchasing program, helping them train their staff and assess their business systems. This will hopefully allow doctors and other healthcare providers to achieve what has been called "meaningful use" of EHR technology.

Once providers have established that they are using the technology, many will be eligible for up to $44,000 in federal incentives over five years under the Medicare program and up to $65,000 under the Medicaid program. Although the vast majority of doctors will be more likely to qualify for incentives through the Medicare program, said David Ford, Associate Director of Policy for the California Medical Association (CMA).

Large hospitals like Kaiser Permanente and Sutter Health have adopted the technology almost 100 percent, Ford said. On Mar. 15 Sutter Health reported that it plans to invest about $400 million over the next five years to complete installation of its EHR system throughout its hospitals.

But only about 13 percent of small and solo practitioners have implemented EHR systems, said Speranza Avram, Executive Director of CalHIPSO. Ford attributes much of the reason for the slower adoption among smaller providers to the cost of the process, the fact that it is time consuming and doctors have to deal with choosing vendors, redesigning their practices and training staff.

The hope is that Cal HIPSO can hold doctors' hands through that process and that the federal incentives will help get doctors started. Physicians will not be required to adopt EHRs, but if they don't, in four to five years they will see a reduction in their Medicare reimbursements.

"We call this the carrot phase of the process, in four to five years there will be the stick phase," Avram said.

In March a study by Accenture, a management and consulting technology services company, and Harris Interactive Inc. a market research company, found that 58 percent of 1,000 U.S. physicians who were currently not using EHRs and were from practices of less than 10 practitioners said they intended to buy an EMR system within two years.

61 percent of those who responded said that they were inspired to buy an EHR system because of federal penalties and 51 said that federal incentives would cause them to do so.  And of those who already use EMR systems, 90 percent said the EMR system changed the way their practice works for the better.