Off to a slow start ...

Unused capabilitiesThe report provides significant insight intowhich EHR capabilities practices actuallyuse, as not every EHR has all functions andnot every medical group fully uses the capabilitiesof its EHR system. More than 97percent of the respondents with an EHRreported that their systems had functions forpatient medications/prescriptions, patientdemographics and visit/encounter notes,but less than 65 percent reported that theEHR provided drug formulary informationor clinical guidelines and protocols.Equally important was that only 83.1percent of respondents said their EHR wasintegrated with the practice billing system.Integration with the practice billing systemfacilitates cost savings by eliminating keyentryof billing information, improvescharge capture and enhances documentationof billed services in the medical record.President Bush has described the use ofEHR and related technologies as a keycomponent in the national health carestrategy of lowering costs, improving qualityand reducing medical errors. However,given the current state of adoption — andeven if all the practices with plans to implementEHR during the next two years do so— at least 40 percent of medical grouppractices will still be using paper records ata critical time in the execution of thisnational strategy.The economic case for EHR is still beingevaluated. Unless the cost barrier to adoptioncan be breached, it may be impossibleto reach the national goal of providing allAmericans access to reasonably priced,quality health services.n o t e s1. Hammons T, Kralewski J, Gans D, Dowd B. The adoptionof electronic health records and associated informationsystems by medical group practices. Finalreport, AHRQ task order No. 5. 15 July, 2005.2. Gans D, Kralewski J, Hammons T, Dowd B. Medicalgroups’ adoption of electronic health records andinformation systems. Health Aff 2005; 24: 1323-1333.@ w w w. m g m a . c o m• In the MGMA KnowledgeCenter in the member area,choose Article Archive andsearch under “electronicmedical records”; chooseTools and try the “Electronichealth record practicereadiness assessment”• In the Store, enter 6266 inthe Search box for the bookElectronic Health Records:Transforming Your MedicalPracticee - m a i l u sAre you planning to implementEHR? What barriers areholding you back? Tell us atconnexion@mgma.comPolicy implications of EHR researchThe implications for Congress and theadministration of the recent research onuse of electronic health records (EHR)by medical group practices are significant.As federal health policymakersdesign proposals to create a nationalhealth information infrastructure, theywill have to take into account the stilllowrates of adoption in group practices(see “Off to a slow start ... ” page 42).Equally important to policymakers istheir desire to see health informationtechnology used to improve clinicalquality and reporting for clinicians whoprovide services to beneficiaries of publiclyfunded health programs. Thepromised improvement cannot takeplace with the current low rates of adoption.The Medical Group ManagementAssociation (MGMA), which conductedthe research with the University of Minnesota,has widely shared this surveywith lawmakers, administration officialsand medical specialty societies.Besides concerns over the lack ofreturn on investment and initial costbarriers to purchasing health informationtechnology, MGMA also has deliveredthese messages to policymakersthrough this survey:• Smaller practices slower to adopt —As expected, larger practices haveimplemented EHR at a higher ratethan smaller practices. In addition,medical specialty practices tended toimplement EHR at a higher ratethan primary care offices.• Complicated implementation/reduced productivity — Surveyrespondents indicated that medicalpractices found it significantly moredifficult to implement EHR thanthey had anticipated. In addition tothe high initial purchase cost,respondents experienced a significantreduction in productivity, atleast through the implementationand acclimation period. Medicalpractices reported decreases in physicianproductivity of up to 15 percent,usually lasting a year or more.Despite a widespread belief that EHRwill increase productivity and reducecosts for practices, the evidence fromthe research demonstrates that productivityis reduced substantially duringthe implementation of and transitionto EHR. Medical practices report thatthe high initial purchase amount andreduced productivity, combined with alack of reliable financial cost/benefitstudies of EHR implementation, makesit difficult to establish a business casefor EHR adoption. The study reportedthat medical groups that have implementedEHR assessed the clinical benefitssuch as improved access to medicalrecord information, improved workflow and improved patient communicationsas far more important thaneconomic benefits.MGMA Connexion • October 2005 • p a g e 45