A patient walks into your office, even for the first time, and instead of being handed reams of forms to fill out – your receptionist glances at her computer, smiles and says, “Hello Mr. Jones, the doctor will be right with you….” For more than 10 years that has been the promise of EHR – Electronic Health Records. The technology exists, and many practitioners have systems in place and are reaping the benefits – but how close are we to universal acceptance and ubiquitous use of EHRs throughout the medical community?

At the most basic level an EHR is an electronic record of a patient’s health information generated by all of his or her encounters with any healthcare practitioner or setting.

But the beauty of EHRs is that they are not only a record of past medical history. Included are patient demographics and things such as progress notes, specific problems, medications, immunization records, et al. 

Many recent studies have concluded that when compared with paper based records, paperless records were more often fully understandable and fully legible.

According to a University of California report prepared for the California Healthcare Foundation that surveyed 20 small physician practices that had implemented EHR, “Almost all users reported increased patient care quality due to such improvements as better data legibility, accessibility and organization, prescription ordering, and prevention and disease management care decision support.”   

Despite the seeming advantages of EHRs, hospitals across the country are evaluating if, when, and how they will subsidize electronic health record technology. Many are hoping that the 19 billion dollars in the so-called HITECH act of the recently enacted Stimulus plan will provide those answers. However, details of when and how such funds will be dolled out remain to be seen. Even the newly appointed Health Information technology Czar himself Dr. David Blumenthal, says implementing the provisions of the HITECH Act faces many hurdles.  


Real World Experiences and Implementation Issues

There are more than 200 vendors who provide EHR solutions to the physicians’ offices. It is evident that we are not dealing with a “one size fits all solution.”

The Reagan Eye Center in Waxahachie, Texas has had NextGen’s system in place since August of 2007. According to Paige Pollard, OD, EHR administrator for Reagan, the key to launching a successful EHR initiative is giving the staff plenty of time to familiarize themselves with the EHR and offering enough training, practice, and support. Pollard explains, “It’s important to be as comfortable with it as possible.”

Excela Health, a network of medical practices representing a variety of specialties located throughout Westmoreland County Pennsylvania, turned to Allscripts to implement an electronic health record system for its more than 115 physicians. “Our strategy calls for finding ways to enable physicians to improve the quality of the services they deliver, simplify their lives, and to improve their bottom line, and we believe Allscripts will help us accomplish those objectives,” said Otto Salguero, chief information officer of Excela Health.

Those who have been through the process of implementing EHRs agree that due diligence and having the proper information and support before, during, and after implementation is critical to its success or failure.  As the old saying goes “fail to plan – plan to fail.”

IT experts agree it is important to think through all the steps in an EHR project from one end to the other. Organizations such as HIMSS and newly launched websites such as EHRtv.com, provide information and valuable resources to healthcare professionals considering an EHR solution.

Dr. Eric Fishman with EHRtv has found that most small practices greatly underestimated the learning curve required to reap the full benefits of an EHR system after initial launch. Many times after implementation practices report an increase in the length of time necessary for documentation, and found they were working longer hours on average, once they had put in EHRs. It is difficult to predict length of learning curves and the impact of learning curves on productivity, but most vendors of EHRs say that typically within 6 months to one year, healthcare providers are leaving their offices at their normal times.

Researchers have found two other important pitfalls practices often run into is not having the right hardware to support the EHR system, and not anticipating the level of the staff’s reluctance to adopt the new procedures. The first can be avoided, say the experts, by working with the vendor and following their “recommended” system requirements and not the “minimum” system requirements. You can avoid the second by “appointing a physicians champion” -a person who can reassure staff, ask for their input and be motivating and enthusiastic about the specific benefits that the EHR will provide.   

Over the next few years, deciding to adopt an EHR will likely be one of the most important decisions made by any clinical practice. The transition to an EHR from a paper system can be challenging, but with extensive planning and proper support many of the pitfalls can be avoided, leading to a successful implementation.