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The Affordable Care Act and the drive for electronic health records: Are small practices being squeezed?
Many small practices find the expense of implementation to be a challenge, but data suggest physicians are getting on board the EHR wagon
Related article: The Affordable Care Act and the drive for EHRs: Are small practices being squeezed? Lucia DiVenere, MD (July 2013)
The HITECH Act also sought to increase the security of EHRs to ensure patient privacy through standardization of EHR products. To become eligible for meaningful-use incentives, EHR software must meet government standards and specifications.3 Common requirements include the ability to document:
- vital signs
- test results
- all medications and allergies.
Another requirement is the ability to generate lists of patients with common conditions.3
By standardizing the EHR format, the HITECH Act improved networking by physicians by ensuring common capabilities among various EHR products.
The funding and standardization established by the HITECH Act increased the usage of EHRs among physicians to 57% by 2011.2
How did we get here? A history of the EHR
Computers and electronics originally were used for administrative purposes and did not offer meaningful clinical applications when they first were introduced to health care during the 1960s and 70s.8 These early machines were large, expensive, and slow and did not meet the practical needs of clinicians. During the 1980s and 90s, however, with networking capability and development of the World Wide Web, the potential for an electronic health record (EHR) became clearer. In 1991, an Institute of Medicine (IOM) report listed the “computer-based patient record” as “an essential technology for health care.”8 The authors of the IOM report envisioned a true network of practices and hospitals that seamlessly and efficiently share information and insight to increase quality of care, reduce medical errors, and improve patient safety.1
Despite advances in EHR technology, one major hurdle remained: cost. For many clinicians, the time and resources required for installation of the program, transfer of records to the electronic format, and training of staff was too high. By 2001, only 18% of physicians had incorporated the EHR.2 Today, nearly 60% of practices use an EHR.
Related article: EHRS and medicolegal risk: How they help, when they could hurt Martin Gimovsky, MD, and Baohuong N. Tran, DO (March 2013)
How to implement an EHR
The first step is to narrow your options to a few vendors that best suit the needs of your office. This process is beyond the scope of this article, but your ultimate objective should be to choose a user-friendly interface from a vendor that offers excellent document security, customer assistance, and support.4
Form an implementation team for your practice, and have it begin by consulting ObGyn practices of similar size that have recently installed one of the EHRs you are considering. By asking about other practices’ experiences and any pitfalls they encountered, you can greatly ease your transition to EHRs.
If possible, the physicians in your practice should visit the office of any colleagues who have implemented one of the EHRs you are considering to see how they like the product. Your office manager, nurses, and receptionist also should visit their counterparts in the other practice to ask about their experiences and opinions. The more information you glean from other ObGyn practices, the easier it will be to make your decision.
Be sure to check with your hospital to ensure compatibility with its system.
Ensure adequate technical support
One of the most important considerations in selecting a product is the availability and quality of tech support from the home office of the vendor. When you talk to other users of a product, ask how quickly tech support calls are returned and how efficiently problems are solved.
There will always be technical problems during the transition away from paper records. Ensuring their prompt resolution will be critical to your success.
Assign project management
After deciding on a particular product, create a project team to manage the complex, lengthy implementation process.4–6 This team should include a project manager who has the experience and skills to coordinate a complex plan, a well-respected product champion who can help maintain staff support for the change, and several information technology (IT) specialists who can manage the software and hardware challenges.4–6
Related article: What can "meaningful use" of an EHR mean for your bottom line? Robert L. Barbieri, MD (Editorial, February 2011)
Rally the troops
The most vital part of any implementation plan is staff “buy-in.”4–6 It is incumbent upon the project-management team to determine what effects EHR implementation will have on workflow and to explain to employees how the process ultimately will increase efficiency and reduce work time and cost. And the project champion must remind employees of these goals during the transition.4–6
Develop a backup system
Work with your IT staff to create a backup system for the EHR to protect against system malfunction.4 In the past, offices backed up their data to tapes or disks. Today, it probably is safer to back up to the cloud. Cloud computing, which allows for automatic back-up, is tightly regulated by HIPAA, so be sure to choose an approved vendor.7