Connecting clinicians panel finds slow progress
A panel discussion during the General Sessions at AHIMA 2006 focused on the state of adoption of EHR systems by physicians and healthcare organizations.

Despite all the benefits of EHRs, a 2005 survey conducted by the Medical Group Management Association (MGMA) showed that 75 percent of respondents were still using paper records and 14 percent were still using EHRs. “Given all the enthusiasm, despite all the efforts, not a lot of people have hopped on the bandwagon -- a big reason why is cost,” said William Jessee, MD, president and CEO of MGMA.

Physicians have seen their operational costs go up more quickly than their revenues in the last few years. “It’s really hard to get people to pay attention to the opportunity to invest when they’re looking at significant cuts in their revenue,” Jessee said. Other factors are a perceived lack of ROI, the need to change workflow, fear of change, and concerns about privacy and security. “People see the cost but it’s hard to quantify the benefits,” he added. “Changing the workflow is a big issue for a lot of practices.”

Those who do implement electronic records, however, experience increased charge capture, improved transcription, records that are easier to find, streamlined medication management, improved security, improved continuity of care, lower liability risk, and enhanced patient trust, and they find it easier to practice evidence-based medicine.

Jessee predicted that within five to seven years, “any hospital or medical practice that does not routinely use an EHR and provide access to personal health records will be an economically unstable dinosaur.” But he also acknowledged that “predictions aren’t always accurate.”

The American Academy of Family Physicians (AAFP) has been setting EHR adoption goals since 1998, said Doug Henley, MD, executive vice president. “It had to be a very high priority for the entire organization,” he said. “This is a significant culture change, so there are no false promises.”

In 2003, the organization established the Center for Health Information Technology, which helps it provide resources and tools for its members. That includes forums for peers to learn from each other. “You can’t overestimate the value of peer-to-peer contact,” Henley said.

Since AAFP surveys show that cost is the biggest barrier to adoption of electronic records, the AAFP has been working to create transparency in the marketplace around price, quality, support, and adherence to standards.

Family practitioners hold a unique place in the healthcare marketplace. They are 8 percent of the physician workforce but are responsible for 24 percent of ambulatory care visits in the United States, Henley said. Therefore, their electronic record adoption has the potential to impact the rest of the industry. The growth of EHR use among AAFP members has grown from 10 percent in 2002 to 30 percent in 2005. That’s a significant rate of growth, but, Henley said, “30 percent is not acceptable. We want nothing less than 100 percent.”

Those who have moved to electronic records have experienced improved job satisfaction, he said. Physicians and the rest of their staff have fewer tedious tasks to manage. They have the ability to demonstrate better quality of care and see improved interoffice communication and patient satisfaction.

Alisa Ray, executive director of the Certification Commission for Health Information Technology (CCHIT), said that certification can be a gateway to encourage health IT. CCHIT is beginning the process of certification for inpatient EHR products and expects to have certified products in May 2007 as well as updated ambulatory criteria. After that, the commission will develop a process for certifying network components.

The commission announced 22 ambulatory EHR products it certified in July and will soon announce the next round of products to pass certification. When asked about the rate of passage, Ray said the group has not yet collected enough statistics before that information can be published. However, the certification process is rigorous, and it’s been clear that vendors have “different levels of awareness and preparation” from realizing at the very beginning that they underestimated the entire process to falling out further along. Certification requires that the product pass every criterion.