Will EHRs Ever Help Small Practices?

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I never met a grapefruit I didn't like, but no matter how hard I try, they never produce enough juice. I'm sure many small medical practices feel the same way about their electronic health record systems. No matter how hard they squeeze, EHRs don't seem to improve the quality of care or help reduce its cost.

Until recently, most of the positive reports on health IT have shown it can generate a significant return on investment both clinically and financially when implemented by large hospitals and group practices. But the latest issue of the Journal of the American Medical Association (JAMA) contains a report that suggests that when practices with fewer than 10 clinicians are equipped with an electronic medical record system -- one that also includes clinical decision support capabilities and registry functionality -- they, too, see improvements in several quality metrics.

The report shows modest improvement in the rate of appropriate anti-clotting drug prescriptions, for instance, as well as better blood pressure control, diabetes care and increased smoking cessation interventions.

While that's certainly good news, two caveats are worth mentioning: The experiment ran for only a year so we don't know if these benefits will continue over time. And more importantly for IT managers: These practices had quality- improvement specialists on board to provide technical assistance.

[ It's time to stop panicking over EHRs introducing more mistakes. For a balanced view, read EHRs Are Not A 'Digital Menace'.]

That assistance included "coaching clinicians on EHR quality improvement features, supporting workflow redesign, and demonstrating proper EHR documentation of the study measures," according to Naomi Bardach, MD, from the University of California in San Francisco, and associates.

That's a lot more than the average small practice will receive in the real world, unfortunately. And that's the heart of the problem. Practices that don't have the deep pockets to afford IT support teams face an uphill battle as they try to master the complexities of EHR technology. Granted, many vendors offer technical support during implementation and afterward, but because vendors now face a long list of demands to meet ever-evolving Meaningful Use regulations, technical support is often meager.

It's now estimated that about 80% of doctors working in small practices will implement an EHR system in 2013, according to a National Ambulatory Medical Care Survey. That kind of demand for product is only going to put more pressure on vendors to sell rather than support.

The notion that poor technical support is one of the major stumbling blocks for small practices was also supported by a recent study in Health Affairs. The study, which looked at the same Primary Care Information Project reported on in the JAMA study, concluded that EHRs help improve patient care but only for physicians who received extensive technical assistance.

"Our study shows EHRs can in fact be a tool for quality improvement, but not in isolation. Technical assistance must be at the heart of the EHR implementation process…." said Andrew M. Ryan, lead investigator and a professor at the Weill Cornell Medical College in New York.

If the nation is serious about digitalizing American medicine, we're going to need a lot more help. In the JAMA experiment, the New York City Department of Health and Mental Hygiene stepped up, and with the help of city, state, federal and private foundation funds, contributed more than $60 million to get the EHR system up and running. We need more government agencies, EHR vendors, and charitable foundations to get involved to make this happen nationwide.