Electronic Health Records

Small Medical Practices Don't Find EHR Adoption Meaningful

Federal incentive payments aren't enough to overcome problems, like increased costs and disruption to workflow, doctor offices perceive with electronic health records.

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Even as the federal government continues to push the adoption of electronic health records (EHRs) by injecting billions of dollars into programs that encourage healthcare delivery organizations to implement the technology, these efforts may not be enough to lure many physicians at small practices to purchase an EHR, Richard Gibson, president of Oregon Health Network in Portland, Ore., told members of Congress

In testimony before the subcommittee on technology and innovation on September 30th, Gibson said that while the majority of 400,000 eligible professionals still need to acquire an EHR, adoption will be toughest in small physician offices that don't have the resources to acquire an EHR or the time and staff to install the technology.

"CMS [the Centers for Medicare and Medicaid Services] has estimated the five-year cost of acquiring an electronic health record for an eligible professional to be $94,000. EHR incentive plans through Medicare and Medicaid will cover 47% to 67% of that estimated cost," Gibson told the committee. "As a general rule, EHRs still do not allow providers to see more patients in a day, spend more quality time with their patients, or guarantee better or more consistent health outcomes for their patients. In short, even with the generous EHR incentive program, there still may not be a sufficient financial rationale for individual providers or small practices to invest in electronic health records."

The Medicare and Medicaid EHR incentive programs will spend as much as $27 billion for incentive payments to eligible professionals and hospitals as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology.

As the EHR incentives program gets underway, however, implementing EHRs at small physician offices "is not like purchasing a copy machine or a fax machine," Gibson said. He noted that installing the technology requires great capital expense, and can disrupt both the clinical and administrative functions of the office.

"Every provider, medical assistant, receptionist, and billing staff member needs to change the way they do their work. Even with excellent training, it usually takes 2-12 months before providers are fully comfortable on their new tools," Gibson observed.

With a new EHR, each office visit takes longer, patients experience an increase in waiting times, and there are a reduced number of patients seen each day by the provider. Many providers on a new EHR, after a full 8-10 hour day of seeing patients, often find themselves completing their charts on the computer at home for three or four hours in the evening. Further, providers have complained about the data they receive.

"Many providers who do not yet have EHRs in their office have commented to me how much they dislike the output received from many other physician office EHRs or from hospital EHRs. They specifically complain about how many pages these EHR reports require and how difficult it is to find the small bit of useful clinical information within," Gibson said.

According to Gibson, much of the unnecessary data is generated from physicians documenting specific history and physical exam findings required to support their billing. Additionally, because of legal requirements, clinicians document with a date-time stamp every single finding and every single item of data that they have reviewed.

"The existing cumbersome EHR reports impair the clinical process and can put the patient at risk by making important information obscure," Gibson said. "Clinicians criticize the EHR for this clumsy reading even though the cause lies with our current payment and administrative systems, and not the EHR itself, which is otherwise widely agreed to be highly legible. Most clinicians would prefer to go back to simpler charting that more closely reflects their thought process. These EHR changes will need to await payment reform," Gibson added.