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Physicians offer reality check on EHR implementation strategies

Physicians doing their own EHR implementations might wonder how big the gulf is between vendor promises and reality. Here, three Massachusetts doctors offer their perspective.

WORCESTER, Mass. -- Solo-practice doctors and physician leaders of small group practices switching from paper to electronic health records systems across the country have the unenviable task of separating the sunshine of vendor promises from the cold, gray reality of an EHR implementation.

Here at the Massachusetts Health Data Consortium's HealthMart10 conference, three early-adopter physicians dished about their experiences, and helped audience members temper their expectations. Their thoughts can be summarized in five key points:

Productivity will drop. Some physicians want to believe it will be simple to "learn while you earn," and open up their EHR system for the first time during an actual patient visit. Thus, they are susceptible to vendor promises that implementing their software will cause the least disruption in patient flow. In his Newburyport, Mass., small group practice, physicians went down to half time in 2006 for the EHR implementation, said Dr. Kevin Lanphear, the group's leader. One went back to full time in a week; the others gradually got up to speed.

Embarrassingly, Lanphear said, it took him much longer -- and it took an extra four to eight hours a day to learn the software and integrate it into his workflow. Months later, he was there. Part of the problem, he said, was that he is a hunt-and-peck typist; learning how to manage data entry through dictation, using a stylus and minimal keyboarding took longer for him than for his peers with stronger typing skills.

Attitude makes a difference. It is true, a particular interface or feature set may ease EHR implementation. The physician's attitude -- as a victim or an optimist -- will make a much bigger difference, however, said Dr. Michael Coffey, a Somerville, Mass., family practitioner who assists docs with EHR implementation part-time as a medical informaticist. Having a positive outlook on an EHR implementation not only will affect the physician, but also will inspire back office and nursing staff to forge ahead, learn the system quickly and better integrate the office workflow.

Don't blow off training. Vendors might say their particular EHR system is so intuitive a physician will need no formal training to use it. That's not going to happen, Coffey said. Physicians should plan at least a long weekend of training, much as they would learn a new medical procedure by traveling to a three-day intensive educational course.

Those who attempt to keep practicing without taking a break for initial training should evaluate and monitor their situations -- and consider such a training session if the going gets tough. "It's very difficult for some of us to say, 'I'm really struggling,' or to even recognize it," Coffey said.

Doctors have to be motivated, and [the motivator] is not going to be money.

Dr. Kevin Lanphear, physician, Newburyport, Mass.

Health information exchange (mostly) isn't happening. The dream persists of health information exchanges (HIEs) freely routing data across the country for the benefit of patients and public-health researchers alike -- but it's just a dream. Even in Massachusetts -- where EHR use is much more pervasive than in other states -- the physicians at HealthMart10 aren't doing much more than exchanging lab-test information between EHR systems and doing office-to-office exchange via secure email. That's still way ahead of most physicians on the EHR implementation curve.

Some physicians are using Concentrica LLC's free, Web-based HIE to exchange PDF documents channeled via email or fax, said Dr. Hayward Zwerling, a Lowell, Mass., endocrinologist who wrote his own ComChart EHR program in 1991 and continues to support it for a small group of users. But that's on a much smaller scale than what's coming.

The networks of interconnected HIEs envisioned by federal health IT planners "is at least five years down the road," Zwerling said. "They're very complicated. There are lots of security issues. An [electronic medical record] is trivial compared to that."

It's for the benefit of patients. EHR systems' cost/benefit ratio is unknown, Zwerling said. Physicians are deluding themselves who think they will switch over and make money on federal incentives, or will find that avoiding Medicare penalties will somehow cover the cost of purchasing and implementing an EHR system. Ultimately, it comes down to what is best for a practice -- and its patients.

"Doctors have to be motivated, and [the motivator] is not going to be money," Lanphear said. "You've got to have a vision of where you're going with this, and what you want to accomplish, and whether or not you want to still be in practice several years down the road, when it's going to be more and more of an expectation for all of us, if not a mandate."

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

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