Electronic Health Reporter

Guest post by Brian White, founder of Competitive Solutions.

Should every physician practice adopt electronic health records? Maybe not. When evaluating the transition to an EHR system, it is critical to consider the long-term efficiency of the practice. Simply put, EHR adoption will not yield operational improvements for every practice.

While many practices using EHRs increase the overall throughput of the business and enhance profitability, others struggle with adoption of the new technology – slowing operations and creating significant financial losses. Many practices repeatedly change vendors or abandon the EHR entirely after significant investment. Making the right decision for your individual practice and navigating the pitfalls of EHR implementation can be difficult and time-consuming. Maximize your potential for success by undertaking a strategic evaluation that includes the following considerations.

If your practice has not adopted EHR, is now the time to do so?

1. What are the operational benefits/detriments of adoption?
a. Will EHR allow the practice to see more patients? Or, will it cause the practice to see          fewer patients?
b. Will EHR require additional labor in the day-to-day function of treating patients?              (In most cases, the answer to this question will be yes.)
c. Will EHR provide the ability to track trends in patient status, statistical data or ease            of access that will be more efficient and/or clinically beneficial?

2. What changes in physician and employee tasks and work patterns will be affected?
a. The perception is that medical records tasks will be virtually eliminated; however,                this is unlikely. Medical records tasks will change but the significant flow of                            information will continue and some level of human interaction will be required.
b. Who will enter the patient medical information into the EHR? How will this affect              the other tasks those individuals currently perform?
c. Will physicians enter information into the EHR personally via pull down lists, check          boxes and radio buttons? Or will a scribe be required to enter that data?
d. The goal of EHR implementation is easy data management. The use of numerical                values and consistent terminology help ensure data can be effectively leveraged to              help physicians consider treatment paths and evaluate clinical outcomes.

3. Are the physicians truly committed to implementation?
a. A physician who is not computer literate will struggle with implementation.
b. A physician who enjoys technology will thrive in implementation.
c. All physicians must understand that more than 100 hours will be required of each              physician to maximize the use of the EHR during full implementation. The                            physician will not be able to delegate this time to a nurse or other employee.

Consider the financial benefits, costs and risks.

1. Few EHR implementations actually reduce staff. EHR will re-allocate and redefine tasks; however, it is unlikely to reduce overall staffing costs.

2. Beware of the increased IT infrastructure and support costs. For many practices, implementation of EHR will require a more complex IT network adding hardware and support costs.

3. If your vendor is recommending an extended period of reduced patient flows during implementation, be sure to quantify that lost revenue in your financial analysis or adjust your implementation schedule to maintain volume.

4. What about meaningful use? Achieving meaningful use will offset some of the costs of implementation; it will also require many practices to collect patient information that may not be clinically important to your practice/specialty.

5. What about the penalties for not meeting meaningful use? Current targets are a potential one percent penalty on reimbursement from government payers. What is your current revenue generated by government payers? If a practice generates $2 million annually in government payer revenue, the penalty will be $20,000 – is that cost offset by the increased profitability EHR will provide?

6. Practices can realize cost savings via reduced office/storage space dedicated to paper charts – how easily can that space be re-tasked for more productive use? Other cost savings should occur in office supplies, efficiency in transmission of information to billing departments, etc.

Stay or Go?

Independent practices may find great benefit from the adoption of a well-implemented EHR. The ease of access to information, data management, cross referencing of treatment risks, and other benefits make EHR valuable.

Other independent practices will benefit from staying the course, using low-tech medical records and simply absorbing any penalties that might be levied. This is a very viable alternative for solo and small practices, as well as practices that focus on a short interval of treatment. If your practice evaluates the patient, treats, follows up and dismisses the healthy patient from care, consider the operational benefit.

EHR is not a one-size, one-software, one-strategy fits all. Practices should stringently evaluate vendors, underlying technology, equipment, support structure and internal resource ability to successfully implement EHR.

Brian White, founder of Competitive Solutions, is a medical practice management expert. For more than two decades Brian has worked with physician practices all over the country to implement new processes and logistics resulting (on average) in an improved annualized practice net earnings of 35-40 percent within the first six months.