Electronic Health Records Get a Check-Up

The market for electronic health records (EHRs) is an interesting one to watch. Government support of EHR implementation is on the rise thanks to stimulus funding; however adoption among hospitals and physicians remains low. A report by Hypatia Research Senior Analyst Sue Hildreth states that the key to attaining benefits from EHRs depends heavily on user adoption. Given the transformational nature of switching over from paper methods to electronic, getting employee buy-in isn't an easy task.

In a conversation with CRM magazine, Hildreth outlined the following roadblocks to EHR adoption:

• physician reluctance,
• constricted budgets,
• confusion surrounding the stimulus package requirements,
• lack of internal expertise, and
  
• cultural changes.

Hildreth references a 2009 New England Journal of Medicine survey indicating that close to 4 percent of physicians have a fully functional EHR system. About 13 percent of physicians' offices have a basic EHR system in the works. Many organizations, Hildreth says, currently have bits and pieces of EHR, but not the full thing.

Full-scale implementations can mostly be found in large hospitals -- those with more resources to dedicate to technology investments. Smaller-scale facilities may not have the bandwidth to spend a lot of time on EHR conversion, the analyst says. Although there are exceptions with smaller hospitals taking the lead in getting EHR implemented, making the switch is costly for healthcare companies -- both in terms of hard costs and soft costs.

"Physician adoption is a critical make-or-break aspect," Hildreth says. If physicians are supportive of EHRs, then it tends to be successful and get adopted widely across the organization. If physicians aren't behind the EHR implementations from the start, it's extremely difficult to get them to use it, Hildreth says.

There are anywhere from 300 packages out there that calls themselves EMR or EHR. The solutions vary from electronic chart packages to full-fledge platforms that integrate patient charts and specialty departments. With EHR implementations, integration is often the name of the game. A lot of times you see healthcare organizations hiring an outside consultant or systems integrator in order to make the pieces fit and get an EHR system up and running. "Most hospitals don't have the expertise in EHR to handle it well," Hildreth says. "The IT department is busy keeping up maintenance and worrying about the existing systems."

Each hospital has differentiated needs for EHR, Hildreth notes. Adoption is often piece-part, she adds. Oftentimes healthcare providers will start in one area, say the emergency room, and begin the conversion of paper records to electronic.

A major point of confusion, Hildreth notes, surrounds the requirements of the stimulus package and what exactly healthcare companies have to do to get the money. "There's some pessimism of whether they will get the money and see reimbursements or not," she says. Additionally, many healthcare providers lack the internal expertise to adequately evaluate EHR.

"Going from paper to electronic can be a huge cultural change," Hildreth says. Doctors and nurses are used to documenting everything on clip boards. When migrating to EHR healthcare workers are replacing paper with computer screens and electronic tablets. The learning curve can be extensive. There's also an issue of inputting the right data. Everything must be included with in standardized data fields. 

Establishing the resulting benefits from EHR implementations is an area of contention, Hildreth says. Since the resources required to implement are intensive, the ROI isn't as clear. However, Hildreth points out specific cases in which hospitals completely eradicated costs in the areas of radiology film and transcription. Also the sheer labor costs involving chart filing can be eliminated. Billing also can become much more accurate with the proper use of EHR.

Patient safety is a big area of potential benefit. Many EHR solutions include decision support and alerts as a feature. The capability, for instance, will flag a doctor if they are prescribing something incorrect to a patient.

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