Wednesday, March 18, 2009

Will EHR become a reality?

I am very excited at the thought that I will eventually have EHR at my office. Sadly, knowing my organization, it will be at midnight on the night of the cut-off, probably in 2015. I have been clamoring loudly for EHR since I started at this job in 2005, as have other physicians in the organization; however, our administration has been resisting, stating start-up costs as the main reason we haven't moved ahead. Now, with money in the national budget set aside specifically for achieving the goal of universal EHRs, perhaps we can start thinking about options.

I recently received communication about a website that reviews electronic medical records. I was intrigued, so I checked it out. Software Advice, a website that reviews electronic medical records, makes some interesting points about the future we are facing, with late adopters joining in the fray at the last minute. Will these providers (and organizations):

  • Truly believe in the value of an EHR over traditional paper charts?
  • Take a leadership role in advocating adoption of the new EHR in their practice?
  • Change their old work flows to match the best practices in leading EHRs?
  • Take part in intensive training to learn the new system?
  • Ride out the difficult stages of new software adoption and change management?
I think that these are valid points, and I will answer each question from my perspective regarding our organization. I think that some of the physicians and mid-level providers do see the value in EHR, but the administration does not. In terms of leadership in advocating for implementation, we have two leaders, our Medical Chief of Staff and our head pharmacist. I think those of us who believe in EHR will be willing to change the way we work, train to learn the new system, and keep working with it until it runs smoothly. I don't think this split will be by age, but rather by comfort level with computer technology. I had the advantage of growing with computers from before they were common (and the hard drive was a cassette player), and although I'm not an expert on computers by any stretch, I enjoy learning new programs. Having worked as a transcriptionist, I'm also a fairly quick typer, so I'm not slowed down by having to use a keyboard vs a pen.

They offer a five point plan to help smooth the transition which relates to the five points above. The organization should have a project manager to coordinate the transition from start to finish. I propose that there be two managers, one medical and one technical, because I think that both perspectives are necessary for successful implementation. Next, the team of doctors needs to be rallied, as well as the patients. The transition will hit bumps, and all team members, from the front desk staff to the patients themselves, need to be prepared and understand that EHR will be an excellent solution, eventually. Training will obviously be key. The better the training provided on the program, the more likely the transition will be smooth. So far, I think this will be one of our biggest obstacles, based on the training the staff have received on other new electronic programs, which is none to be exact. Their fourth point is to keep it simple. Amen to that. The transition may need to be gradual, and the EHR will likely evolve as the process goes forward. Finally, the practice will change, be it by medical staff carrying around tablets PCs or by having PCs in the exam rooms. This will require adjustment by medical assistants, nursing, providers, and families. I happen to strongly believe that EHR will be a safer, more efficient way to practice medicine, but I am bracing myself for the transition.

I do, however, disagree with the authors of the website on one main point. They feel that EHRs should not be free, that people only value what they pay for. While I see their point, I think that for certain organizations like community health centers, the cost of establishing an EHR is absolutely prohibitive. I know that the money will eventually be re-couped by improved billing and improved efficiency, but the start up capital is a real challenge. In addition, if this is something that is going to be required, at least a subsidy needs to be available to help. Maybe there can be a basic form of EHR which is available free-of-cost to all providers, and then practices that can afford a version with more bells and whistles can pay extra. I don't know if this is the right solution, but it's just a suggestion.

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