Electronic Health Records

Adoption & Implementation News

What makes meaningful use challenging for small practices?

By Kyle Murphy, PhD

- Success in the EHR Incentive Programs can be a straightforward process for large health systems, hospitals, and healthcare organizations with the resources and infrastructure necessary to support EHR adoption and use. The same is not necessarily true of small medical centers, especially small physician practices.

While the challenge is significant, these eligible professionals do have local resources available to them, such as the regional extension centers (RECs) established by the Office of the National Coordinator for Health Information Technology (ONC). Another, perhaps lesser-known resource is each state’s medical society which have had to adapt their focus and outreach to include more health IT-related support.

As the Chief Medical Officer of the Pennsylvania Medical Society (PAMED), Gus Geraci, MD, has seen his job and the work of the organization expand to include EHR adoption and meaningful use to help physician members. In the first installment of a two-part interview with EHRIntelligence.com, Geraci explains why meaningful use represents a major undertaking for small physician practices.

What are you hearing from PAMED physicians about their current work with health IT?

Obviously, the big thing these days is meaningful use and the EHR Incentive Programs as they are evolving. There are certainly physicians who believe strongly in the concept of electronic records to help them be better documenting and taking care of patients. Electronic records have the ability to do things you can’t do in a paper chart. The initial promise was improved documentation, better reporting, better care, ease of use, etc., but the reality is that many physicians are finding that the utility, workflow, ability, and mandate to use electronic records actually interferes with their ability to efficiently and appropriately take care of patients.

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There still are a lot of physicians who haven’t dipped their toes in the water in terms of electronic records. I’ve seen numbers allegedly as high as 70 percent of physicians having EHRs. Frankly, I have a little trouble believing that number. And if you a little under the covers, you have to ask how they define an EHR and they say that that 70-percent number have a basic EMR. If you look at their definition of a basic EMR, it’s pretty much electronic billing. If you turned it around that way and ask how many docs use electronic billing, I would say that number is closer to 100 percent, but that’s not an electronic record.

Why is EHR adoption and by extension meaningful use such a challenge for these providers particularly?

In the middle of my career, I started a practice in family medicine and I bought an electronic record before anybody had one here in Central Pennsylvania, and it was funny because there were vendors who literally wouldn’t even talk to me. I told them I was a solo doc who wanted an electronic record, and they’d laugh and hang up on me. It’s been an interesting path coming from that to today.

Even then in the dark ages of the late nineties, I had vendors come in and say, “Our product is wonderful,” and it just made no sense how they you to use it. And I have to say déjà vu all over again because I look at some of the requirements now that have been put in place by some vendors to satisfy the meaningful use requirements and it’s back to that. It’s back to having to leave a record, find another spot to check boxes, and then go back to the record — all theoretically while seeing a patient.

Clearly, (1) it can’t be done and (2) it’s full of extra steps that shouldn’t be necessary but were necessary in the eyes of that vendor to meet the meaningful use requirements. They met the need as it was presented to them, but they did not meet the workflow or interaction requirements that are critical in a real-time operator environment.

How is PAMED helping physicians participating in meaningful use?

We have resources here within the medical society and also within our subsidiaries. We have a consulting subsidiary that is assisting with the implementation and workflow issues. On a day-to-day basis we have resources here in the medical society whose job it is to understand and know the meaningful use rules and regulations, what it means to be audited, how to get through an audit, and those kinds of things. If it’s a quick-and-dirty question — what do they mean when they say this? — that’s freely available to all medical society members.

There is a regional extension center, the Pennsylvania Regional Extension and Assistance Center for Health Information Technology, and they have actually contracted with our consulting company to assist them in their work, along with others. Internally, we have a monthly meeting with the folks from the REACH centers, our internal resources, and other representatives from the state who are active in HIT, and it’s called the HIT Meeting and we hash out for two hours all the issues that are happening out there. We try to help by crossbreeding resources and spreading the wealth. So we stay in touch with the Department of Welfare, the Pennsylvania eHealth Partnership Authority, the immunization registry, commercial insurers — all of the folks who have finger on the pulse of HIT in the state.

Check back tomorrow for the second part of this interview.

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