Like a diver’s tricky ascent to the surface, adjusting to EHR technology in small practices is not consistently seamless. It can leave some providers with the figurative bends; reports from various practices have tied the process to decreased productivity, curtailed speed and frustration.
“It’s hard for physician practices because of resources overall,” said HIMSS Healthcare Information Systems Senior Director Mary Griskewicz of the implementation process. “Time is probably the number one reason, also cost, and change. It’s getting the physician to do things differently.”
Just how steep is the EHR learning curve for small practice physicians? And what’s being done right now to level it?
Steve Furr, MD, is a physician at IMC Family Medical of Jackson, Ala. The practice began implementing the TactusMD EHR in 2000. Shifting from paper charts to electronic software was “an intense process,” he said, “but absolutely worth it.”
The largest hurdle Furr and his colleagues at the five-provider practice faced was re-building patient databases, from ink to type. “I think the most difficult thing is when you first start putting patients in and getting the data into the system. We’ve been a practice for a number of years, so we have all these big paper charts,” he said. “So when you have a patient come in, it’s just like starting all over again. You’ve got to get their diagnosis in, and their medicines in. The first six months or so are labor-intensive as you get that into the system.”
The paper foundation that medical records in the small physician practice seem to be built upon stems back to a provider’s time in medical school, Griskewicz explained. “Medical schools are still doing things on paper; a lot of clinicians don’t get exposed to electronic health records until they get out of medical school.”
In order to prevent productivity losses when shifting from paper records, Furr and Griskewicz stress that EHRs have to be tailored to a physician’s workflow -- from the outset.
“A lot of the systems are built for the primary care physicians – and even some of the primary care physicians say, ‘This isn’t my workflow; this isn’t how I do things,’” noted Griskewicz. To rectify this, especially as the demands of meaningful use incentives grow more challenging over the next few years, “the vendors are going to have to pay attention to what the physician community wants based upon their workflow and based upon the way that they practice medicine,” she said.
Michael Anderson, MD, is a pediatric physician at the Children’s Pediatric Center in Canton, Ga. He was hesitant to dive into the realm of EHRs and select one for his practice. “I was very skeptical – I didn’t know anything about it. I was starting a brand new practice and the people advising me about the new practice said, ‘The future’s coming; you need to get this thing before you start,’” he commented. “But now I wouldn’t imagine practicing medicine without it.’”
The Children’s Pediatric Center – which is led solely by Anderson and his wife, a registered nurse – began using TactusMD’s EHR solution in 2004.
Both Furr and Anderson stress that they’ve hit upon a solution that’s exactly what Griskewicz calls for: a tool built with the provider in mind. Furr’s six-month initiation period was difficult because he was shedding the practice’s paper process, he said, not because of his EHR’s configuration.
“Once you get your information into the system, it’s much easier to follow up with patients and keep up with them,” he said. “It’s very quick, very intuitive and it’s very easy to follow. For physicians, I would encourage them to look at a lot of different EHRs and look at what works for their workflow. The key thing for an EHR is that it allows you to manage your patients better, still letting you do the things that you do.”
Furr and Anderson echo: When an EHR aligns with a workflow, it can be a catalyst for improved care and practice management. They’ve both heard from colleagues who’ve experienced productivity losses due to EHR implementation. But because of the tailored nature of their systems, they said, their practices didn’t experience such setbacks. Their cases seem to solidify the potential for EHRs to generate forward motion, not roadblocks.
Anthony Mari, MD, founder and CEO of TactusMD, thinks that these reported roadblocks have been causing many physicians to shy away from EHRs. “I see smaller practices starting to jump in so they can take advantage of government funding, but I think there are still a majority of primary healthcare professionals taking a backseat because they are really concerned with productivity losses.”
To re-route this, Mari -- like Griskewicz and the two Tactus users – believes that software has to mesh with physician work habits. “It comes down to ease of use,” he said. “If we switch the focus back on meeting the needs of the patient, and letting the software take care of the needs of the business and the insurance companies, I think it’s a win-win.”
And if this switch occurs, what would it mean to for the future of EHR implementation?
“I think EHR use is going to be the norm, absolutely,” said Griskewicz. “I think as the technology evolves, as standards evolve, as the clinicians get more comfortable with the technology -- and the vendors build to the specifications and the needs of the clinician in multiple specialties -- we will see that.”
Furr, Anderson, and Mari think this will be the case, too, if the vendor/physician relationship solidifies. And once it does, Griskewicz, is looking forward to seeing the focus shift from implementation to improving patient care though confident EHR use:
“My goal one day is to be talking more about the clinical and business intelligence of it, versus the adoption and the use,” she said. “I encourage clinicians to continue to really raise their voice to let it be known to those building the systems and developing the standards what’s really important to them. It’s a process with which we all need to be involved. “