Pediatric Informatics: Computer Applications in Child Health (Health ...

17 Aligning Pediatric Ambulatory Needs with Health IT 247
During the first 6 months after deployment of an ambulatory EHR, most practices
report decreases in the number of patients seen while providers ramp up on the
system. In one study, 17 one practice reported almost 18 months before productivity
with the new system returned to normal. Larger practices may choose to migrate to
the EHR in small subgroups of physicians, to minimize productivity loss. 18
Smaller practices represent a significant portion of community (and pediatric)
practices. 63 The self-reported EHR adoption rate across solo practices was about
14% in 2003, 64 which is a much lower rate than for their larger counterparts. 58,63
Small practices face much greater individual risks when they do adopt EHRs,
including a higher cost per full-time physician, 65 and a higher impact of income
loss per clinician during initial deployment – which magnifies risks of failure,
frustration and stress.
Perceived barriers to adopting EHRs are many, including financial costs, expertise
(hardware, software, IT), training and maintenance needs, and loss of income
during deployment. These barriers are compounded by uncertainty about data
becoming unavailable if a vendor goes out of business. 65 In response to this, collective
efforts to reduce these uncertainties have been launched.
To reduce the risk in purchasing a system, a recognized certification body
(CCHIT, the Certification Commission for Healthcare Information Technology 66 )
provides certification of EHR products, but does not reduce the cost, which may
be several thousand dollars per provider. 67 More certified products are providing
pediatric-related features (such as weight based dosing, preventive care reminders,
and growth charts), and CCHIT is in the process of developing a pediatricspecific
certification for EHR products to accelerate this process.
To allow pediatricians to “compare notes” on specific pediatric EHR products,
the American Academy of Pediatrics Council on Clinical Information
Technology (COCIT) has established an Electronic Medical Record Review
Website, 68 a free online resource for pediatricians to share their experiences
concerning EHR products and vendors.
17.6 Conclusion
In the ambulatory setting, health IT adoption is increasingly being driven by the
desire for decreased cost, increased quality with respect to performance measures,
and increased clinical productivity. These aims are in their early stages of realization,
as EHR adoption rates are low in pediatric ambulatory settings, especially
in the setting of small practices. Adoption is a complex process, with initial and
ongoing financial, organizational, and technical investments required; and the
potential for revenue loss during deployment. The strategy of adopting health IT
solutions with low impact on clinicians’ workflow but high returns first may prove
to be a useful strategy towards the eventual widespread implementation of comprehensive
EHR systems.