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The Surgeon General's prescription for a smooth EHR implementation

Dr. Regina Benjamin talks about what makes an EHR implementation successful. She's found it pays to focus on disaster recovery, interoperability and reluctant physicians.


Dr. Regina BenjaminDr. Regina Benjamin
U.S. Surgeon General

ORLANDO, FLA. -- What's the key to picking the right vendor for an electronic health record (EHR) implementation at a solo physician's office or small group practice? It's trying several different vendors' software and making ease of use the top priority. That advice comes from none other than Dr. Regina Benjamin, who went through her own vendor-selection process en route to being named U.S. Surgeon General last year by President Barack Obama.

Benjamin's Bayou La Batre Rural Health Clinic in Alabama was battered by two hurricanes and ravaged by fire in the last decade, inspiring it to switch from paper to electronic charts.

"It came down to which one was the easiest to use, based on the way we practiced," Benjamin told in an interview after she delivered a keynote address at the American Health Information Management Association convention. "No one company is better than another; they all have their [strengths]. It's like buying shoes -- what's your personal preference, personal style; and what fits you well?"

Benjamin encouraged physicians to tap into the resources available to them. When her practice switched from paper to an EHR system several years ago, vendor-neutral documentation from the American Academy of Family Physicians' Center for Health IT helped narrow the choice. (eClinicalWorks Inc. eventually donated the software.) Since then, the federal government's regional extension centers also have emerged as a major asset in the EHR implementation process, and give solo and small group practices "even less reason" to put off the switch, she said.

Getting physician buy-in for EHR implementation

Physicians who are reluctant to start usingEHR software will likely become fans once they're pushed into the pool, Benjamin said. Once they do, they will look back at the era of paper charts with shoulder-shrugging nostalgia. She advocates going "big bang" -- implementing EHR, practice management and billing all at once instead of, for example, starting with just billing.

"You trust your money with electronic [systems] and you don't trust the patients' information?" Benjamin asked. "The patients' health information is more important. We can replace the money, but we can't replace the patients' health information."

Even though some older doctors at a hospital might initially resist adopting the facility's EHR system, Benjamin encourages hospital CIOs in charge of EHR implementation to keep on those doctors and revisit it. Even older doctors are doing their own implementations of smartphone technology -- and if they can figure out how to Skype with their family members, they can figure out EHR software.

"The fear's not there as it was in the past," Benjamin said. "Once they're into it, they're getting this. . . . [I]t usually takes something like grandkids to motivate them."

In an EHR implementation, don't forget disaster recovery, PHRs

A lot of the media coverage and conference analysis of EHRs' benefits focuses on potential quality improvements to patient care and the potential cost savings they'll bring. Benjamin's story also illustrates how EHR systems are an important part of a disaster recovery strategy. An EHR system not only will keep a practice in business but also will help keep patients healthier in the event of a fire or flood, she reminded the physicians -- but only if off-site backups are part of the EHR implementation plan.

No one EHR company is better than another; they all have their strengths.

Dr. Regina Benjamin, U.S. Surgeon General

"I had been there 23 years, I knew my patients really, really well," Benjamin said of her Bayou La Batre clinic, recounting how they struggled to recreate records from scratch after the paper copies burned in a construction fire during the clinic's post-Hurricane Katrina rebuilding. "But I couldn't remember all their medications, I couldn't remember all of their allergies. I could remember the big ones, but they shouldn't have to depend on my memory."

Don't neglect personal health records (PHRs) either. Yes, they are part of meaningful use, but the more important thing about PHRs is that they enable the exchange of basic health information when a patient goes from a family doctor to a specialist and back again. That helps all the parties involved keep track of medications and treatment details.

Benjamin hopes that the Office of the National Coordinator for Health Information Technology's efforts to bring interoperability to EHR systems will ultimately succeed, because physicians -- especially solo physicians and doctors at small clinics in rural areas serving poor patients -- will be able to switch EHR software at a minimal cost, if the system they buy doesn't work well.

"I think we have a long way to go in making sure [EHR systems] communicate with each other, so you don't get stuck with one company -- if you want to change tomorrow, you can change." Benjamin said.

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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