In response, 3 private sector health information management groups jointly formed the Certification Commission for Healthcare Information Technology (CCHIT; www.cchit.org). In 2005, this private-sector entity entered into a contract with HHS, to, in the commission’s words, “develop and evaluate certification criteria and create an inspection process for healthcare information technology” in 3 areas:
- Ambulatory EMR for offices
- Inpatient EMR for hospitals and health systems
- The network components through which EMR share information.
Pay-for-performance pushes the issue. Today, insurers—federal and private— are mandating adherence to standards of care for maximal reimbursement of services. These reimbursement schemes, called pay-for-performance, or P4P, are based on providers delivering documentation that specific protocols are followed and outcomes are monitored. The point is that it will be nearly impossible for physicians to comply with insurers’ P4P requirements unless that documentation is in an electronic format.
The market speaks—loudly. Other forces are bringing clinicians to a reckoning with EMR:
- Some malpractice carriers offer a discount on premiums to physicians who document work using EMR
- Patients are asking for electronic access to their providers by way of Web sites and e-mail
- More and more requests for documentation from multiple interested parties to a patient’s care increase overhead costs and place greater demands on paper-based systems.
Reticence has been the watchword
Despite the external and internal forces that are driving adoption, physicians have, as a whole, been reticent to adopt EMR. The nonprofit Healthcare Information and Management Systems Society (HIMSS) reports that 26% of ambulatory practices have adopted EMR, but this penetration is predominantly in multi-specialty clinics and hospital-owned practices.2 Few data exist on the penetration of EMR in single-specialty ObGyn practices; anecdotally, vendors estimate a penetration of 10% to 15%.
Why this slow pace toward something broadly acknowledged as key to the well-being of health care?
It means a change. Adopting EMR represents change; well-designed EMR systems streamline workflow in a practice by automating many functions, eliminating duplications of effort, and shifting roles from moving paper to managing digital information. Fear of change and resistance to change are the most common reasons that single-specialty ObGyn practices have not adopted EMR.
It costs. Expense is often cited as the reason why a practice has not adopted an EMR. True: Upfront hardware costs, software costs (license fees, subscription fees), implementation fees, and training costs add up. But a well-designed EMR system should provide a substantial return on investment (ROI) based on savings and on an increase in revenue.
It may be awkward. Some physicians cannot type well. They do not adopt EMR, therefore, because they fear embarrassment using a computer to enter clinical documentation in the consultation room in front of a patient.
On the plus side
On the other side of the coin, the advantages of EMR to physicians are several:
Documentation. EMR facilitate complete documentation of a patient’s visit, current needs and care plan, and record—thereby reducing the clinician’s liability and the risk of medical error. Functions include order entry, prescribing, accurate coding based on work-effort, tracking of outstanding lab tests, and notification.
No chart pulls. With EMR, patient chart pulls are almost nonexistent. A chart is available anywhere a computer is located, any time it is needed.
Decision-making. Probably most importantly, EMR provide clinical decision support by means of alerts (drug interactions, allergies) and reminders (need for follow-up, test orders).
Portal to the patient. Internet-accessed portals that are part of EMR systems facilitate asynchronous communication with patients. A patient can make an appointment, refill a prescription, and request educational materials through such a Web portal. Once an appointment is scheduled, the patient can enter her medical history so that it is specific to the appointment—a feature that is particularly useful when a woman knows the reason that she is visiting the ObGyn (“I’m pregnant,” “My cycle has changed”).
Such a patient-entered history can populate the EMR and contribute elements for appropriate coding. Furthermore, a Web portal in an EMR system enables the physician to reply to a patient with secure messages 1) about lab results, reminders, and appointments and 2) that deliver educational materials.
Keys to embarking on a successful transition
Because EMR are still used by only a small minority of practices, those that seek to move away from the paper record are almost always doing so for the first time. Uncertainty about the adoption adds to anxiety. There are, however, simple steps to take to maintain control over the adoption process and methodically manage it to a successful outcome.