Wednesday, November 7, 2007

Docs need EHRs, but shouldn't count on ROI

The “tipping point” for placing electronic health records into physician practices has already been reached. But the probability of seeing any return-on-investment after implementation remains years away.

William Bria, MD, chief medical information officer at Shriners Hospitals for Children, voiced these opinions at the HIMSS Virtual Conference & Expo on Tuesday. Bria headlined an education session at the event entitled “How to Introduce the EMR in your Office with Minimal Bother. ”

“Implementing an EHR system is not a minimal fuss for a practice, it’s a major fuss,” said Bria, who also serves as chairman of the board of the Association of Medical Directors of Information Systems. “If done poorly it can be a disruptive mess.”Bria emphasized the complexity of turning a paper-based practice into a digitized healthcare space, but he stressed that major gains in patient care could be achieved, so long as workflow was optimized.

“The workflow aspects of healthcare are similar in complexity to those in aerospace,” he noted. “When you talk about automating a medical practice, that complexity has to be given some respect.”Bria cited research by the Indianapolis-based Regenstrief Institute that found physicians using EHRs only spend about 0.43 additional minutes with each patient, when duplicate and administrative tasks are taken into account.

And those physicians surveyed firmly believed that information technology improved patient care, Bria added. Determining the ROI associated with EHR use is difficult for physician practices, Bria told conference attendees. The “real” cost of implementation isn’t just the investment in computer hardware, software, and vendor support services.

“The hidden cost of an EHR is the amount of time you’re going to have to spend changing your practice as a result of implementing,” Bria said. “You will be inefficient initially as a result of the change. That’s why an EHR implementation is a long-term process.”It’s important for physicians to ask tough questions of EHR vendors, Bria affirmed. He said that the EHR certification process run by the Certification Commission for Healthcare Information Technology could make purchasing decisions easier.

Nevertheless, physician practices need to more clearly explain their day-to-day workflows to vendors. “Physicians need to tell a vendor’s sales staff exactly how their practice works and what they need from EHR software,” said Bria. “You need to ask a vendor specific questions.”Some of those questions might include: Does an EHR automate suggestions or orders for common health screenings (such as vaccinations and cancer screenings)? Will it allow data input by “less-expensive” employees in the physician practice (as opposed to physician-only input)? Will the EHR provide high quality actionable data for all of the providers? No ambulatory EHR product is a good fit for every practice, Bria said, and no single system provides perfect clinical decision support.

For this reason, Bria cautioned that physicians should not assume an “automatic diffusion of improved quality of care” after buying an EHR. “I’ve been doing applied medical informatics for 30 years, and the match between the technology and what we do as physicians is not yet where we need to be,” said Bria. “But that doesn’t mean you should wait [to implement healthcare IT]. You just need to get involved and make sure a product is configured to your practice’s needs.”

Source: Healthcare IT News

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