| Adopting EHRs for Small-and Medium-Sized Practices |
| Column | |
| By Jack B. Smyth | |
| Wednesday, 18 July 2007 | |
 Barriers to adopting electronic medical records are becoming more relaxed. The American Hospital Association conducted a survey of community hospitals in 2005 to measure the extent of IT use among hospitals and better understand the barriers to further adoption. CEOs from 900 community hospitals participated in the study, which found that 92 percent of the respondents were actively considering, testing or using IT for clinical purposes. The remaining 8 percent that were not considering IT were primarily small, rural, non-teaching and non-system hospitals. The study reported that more than 50 percent of the respondents fully implemented the EHR functions. This study also reported that 50 percent of the rural hospitals specified they were just “getting started” on IT system implementation, whereas 48 percent of the urban hospitals indicated moderate or high levels of implementation of IT systems. Cost was the No. 1 barrier to the adoption of EHR systems. Fifty-nine percent of the hospitals found that initial cost was a significant barrier, while 58 percent found acceptance by clinical staff as somewhat of a barrier. Among the smaller hospitals with fewer than 300 beds, more than 50 percent saw cost as a significant barrier. A study was conducted in 2004 by Healthcare Informatics in collaboration with the American Health Information Management Association to measure the level of readiness of health information management professionals and the extent of EHR implementation in their organization. The findings showed the industry is continuing to see more movement toward EHR. When organizations were asked to describe their progress toward an EHR, 17 percent of respondents indicated they were extensively implemented; 26 percent indicated they were partially implemented; 27 percent said they were selecting, planning or minimally implemented; and 21 percent indicated they were considering implementation and gathering information about it. In a study conducted during the summer of 2004 by the American Academy of Family Physicians (AAFP), nearly 40 percent of respondents, who were members of AAFP, indicated they either had completely converted to EHRs or were in the process of doing so. Twenty-four percent had purchased the EHR system within the first half of the year. Findings showed that cost remained a major barrier for physicians in small and medium practices in the move to EHR systems. Previous research on risks of EHR systems identified privacy and security as major concerns. The major barrier to adoption of an EHR system, as identified by some studies, was misalignment of cost and benefits or financial reimbursement. The Time is Right Recently, however, some of the key barriers to EHR adoption have been relaxed, resulting in streamlined workflow, improved patient care and a reduction in medical errors for many small- to medium-sized practices. While adoption rates among small- to medium-sized practices are estimated to be as little as 10 percent today, interest and implementations are increasing rapidly, driven largely by recent technical, business and regulatory developments such as: • Changes in the Stark Provisions – As a result of the new Stark exception and anti-kickback safe harbor act, organizations are now permitted to donate as much as 85 percent of the cost of technology purchases to physician offices in order to create, maintain, transmit or receive EHRs. Practices around the country now stand to receive considerable contributions towards their purchase of an EHR. • Recognized certification programs – The EHR market consists of more than 200 products, each with various levels of quality and capability. Not surprisingly, diligent research and expert referrals become a necessity when choosing an EHR for your own practice. As a result, The Certification Committee for Health Information Technology (CCHIT) and other recognized standards have set forth benchmarks for functionality, security and interoperability to dramatically reduce the risks of purchasing an EHR. Now, physicians can depend on established standards to guide them in choosing a quality product from a credible company. • New reimbursement models – Pay-for-performance (P4P) is a new reimbursement model now being tested or piloted by both government and private payers. P4P ties medical reimbursements to key performance measurements and relies on the use of technology to succeed. For example, an EHR collects the clinical data necessary for real-time reporting of quality measurements and allows for accurate results-sharing with third-party payers, thus maximizing reimbursements. • Inexpensive, easy-to-use EHR software – The new generation of EHR software can now be implemented for as little as $5,000 per doctor as compared to the $9,000 to $10,000 per doctor of the older-generation EHRs. Products such as SpringCharts EHR can be installed an operational in just a few days with little interruption to the practice. There are vast benefits to implementing an EHR system, significantly impacting the physician, the practice staff and the patient. For the physician, the ability to access any patient information at any point in time is one of the most useful benefits. Physicians can track the medications a patient is taking, assess results from tests and quickly reach a diagnosis. This information gives clinicians the ability to determine which treatment options work best for a patient and use this information to make informed care decisions. Other benefits to physicians include more accurate and complete charting, the ability to see more patients in less time and higher coding. Instant access to a patient’s electronic health record also saves the clinician’s staff precious time by alleviating the need to sort through cumbersome paper charts. Using an EHR, simple electronic searches retrieve a patient’s complete medical record from any office desktop. Before seeing a patient, staff members are able to review the patient’s medical history, current medications, problem list and more. Major cost-saving benefits experienced by the staff include dramatically improved workflow, elimination of lost or misplaced charts and dramatically lower transcription costs. Through technology, patients can have a higher confidence level in their physician with the elimination of medication errors through misread prescriptions and potential cross-medication complications. By visiting a connected office, patients also benefit from faster and more efficient office visits. Ready to Implement With many of the stumbling blocks to adoption by small- and medium-sized practices quickly disappearing, there is no longer any reason a practice should wait to implement the current generation of CCHIT-certified EHR software. This benefits the clinicians and their staff and, most importantly, improves patient care. Jack B. Smyth is president and CEO of Houston-based Spring Medical Systems Inc., a software company founded by physicians and technology professionals. He can be reached at 281-537-0186. |
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