Doctors in Small and Midsize Business Should Have Electronic Health Records (EHR)

When the Vioxx recall hit in late September 2004, it was almost a yawner for Peter Basch. "It took us two or three minutes to figure out which of our patients were on it," says Basch, who is part of an eight-doctor practice in Washington, D.C. That two to three minutes was how much time it took to structure and execute a search for the practice’s electronic records database.

Basch says that the Vioxx recall was a noncrisis for his practice largely because he and the other doctors have been using electronic health records (EHRs) for the past nine years. In fact, the first major drug recall occurred the same year Basch’s practice started using EHRs. In September 1997, the Food and Drug Administration warned doctors against prescribing fenfluramine and phentermine (Fen-Phen) together as appetite suppressants. At that time, Basch’s practice needed about 30 minutes to find all of its patients who were taking the diet pills. Basch, though, doesn’t even think that quick-search capability is the best reason to use electronic health records. Instead, he points to not having to write out prescriptions.

One of his patients was on more than 15 medications and would never get them refilled. He had to write them all out for her twice a year. "That was incredibly painful," he says. "When I could do it in a couple of clicks, I was able to smile at her and say, ’Anything else?’"

Basch is a great white-coated hope for much of the medical industry—a doctor in a small practice who is using electronic health records and believes in them, he says, "with almost religious fervor." But such faith is sparse among doctors. Basch estimates that EHRs are used by no more than 15 percent of the 800 doctors employed by MedStar Health, the seven-hospital corporation that owns his practice. And so far only 14 percent of all the physicians in the United States have invested in EHRs, according to a 2005 survey by the Medical Group Management Association.

Many physicians say they simply don’t see the financial upside for their practices, and some are concerned about retaining the confidentiality of patient information. (For more on health privacy concerns, read "The Electronic Bogeyman" on Page 68.)

"How do you convince a practice to spend between $20,000 and $40,000 a physician and decrease productivity and disrupt the practice for a year to make the change to these systems?" Basch asks. "That’s a tough argument to make in the current environment."

The Argument for E-Medicine

Nonetheless, health insurers, hospitals, and state and federal agencies are determined to make that argument succeed, if only because of the potential of EHRs to improve the quality of health care and reduce its costs. A Rand Corp. study published in Health Affairs in the fall of 2005 estimated that the broad use of EHRs would cut $81 billion from operating costs. That same study estimated that if most hospitals used EHRs, it would eliminate 200,000 mistaken drug prescriptions a year, saving $1 billion. Then there are the countless hours that patients and staff spend filling out forms, and then finding them—one study estimates that doctors can’t find the records needed for 30 percent to 40 percent of their patient visits.

The effort to accelerate the rate at which the hundreds of thousands of physicians in small practices who don’t use electronic health records (roughly 75 percent of them) adopt such systems is proceeding on several fronts. The U.S. government has four major standards efforts under way to provide guidance for electronic data exchange by doctors, hospitals and insurers. Congress is also considering relaxing elements of the Federal Medicare and Medicaid Anti-Kickback laws and the Federal Anti-Referral Law so that hospitals might help doctors in their regions adopt electronic health record systems. (For more on the national health records initiative, read "What Happened to Do No Harm?" on Page 42.)

The physicians and IT executives who have taken the lead in implementing EHRs say there is a strong business case for investing in these systems. In interviews with CIO, these early adopters provide a number of valuable tips for how to make the business case to doctors in small and midsize practices and help them over the implementation hump. With national, state and local initiatives starting this year, they say, the momentum for widespread EHR adoption is building.

"It’s happening very fast now. The funding to do it isn’t there yet, there are cultural barriers, legislative barriers and privacy barriers—but there is now a national effort to overcome all of these barriers," says John Halamka, CIO of the $1.2 billion CareGroup, a system of hospitals and practitioners that includes Beth Israel Deaconess.

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