Electronic Health Records


Why are small practices essential to widespread EHR success?

By Kyle Murphy, PhD

Small practices trail larger counterparts in their overall adoption and use of electronic health record (EHR) systems. But they are critical ultimately to the success of the Centers for Medicare & Medicaid Services (CMS) EHR Incentive Programs and initiatives funded through the Office of the National Coordinator for Health Information Technology (ONC). This according to a recent study in Health Affairs released online in advance of its print publication in May.

The authors emphasize the pivotal role of small practices in ensuring that US health care meaningfully uses EHR systems in the years to come to improve patient health and reduce the cost of quality care across the nation.

This broad initiative is intended to raise overall adoption levels. Federal programs initiated by the 2009 legislation are targeting primary care providers and physicians in small practices. To achieve the stated aims of widespread use, the programs will need to continue to aim incentives and support at small practices. (Decker et al. 2012)

Although hospitals are the largest beneficiaries of CMS EHR incentives to date, they pale in comparison with small practices in terms of the volume of patients seen. In 2006, as part of their analysis of national health trends in the US, the Centers for Disease Control (CDC) showed that small practices (less than five physicians) constitute nearly 75% of all health care providers. As Director of the Regional Extension Center of New Hampshire (RECNH) Jeff Loughlin adroitly puts it, “The money is at hospitals; the patient volume, at small practices.”

The ONC strives to reduce the gap emerging in the use of EHR systems between large and small practices through the REC program after discovering that finances weren’t the only reason that small practices were adopting EHR systems more slowly. “EHR adoption is about time,” says Loughlin. These smaller medical settings don’t have the necessary time to implement an EHR system alongside their day-to-day activities. Staff resources at these sites are equally small and may only comprise a practice manager and a few medical assistants. Getting small practices to select, implement, and meaningfully use EHR technology requires outside assistance, such as what Loughlin and his team provide through RECNH.

Small practices will play a significant role in the future of health information exchange (HIE), a cornerstone of Stage 2 Meaningful Use. And the use of EHR systems will have a meaningful impact on the viability of these practices, many of which provide health care areas of the country located hours away from resource-rich hospitals. As Loughlin notes of younger physicians, “The younger crowd tend to go to larger practices.” Without EHR systems, small practices may not be able to compete with hospitals and large practices for top physician candidates, distinguished by their wealth of resources and technology.

Unlike small practices, hospitals have been well ahead of the curve in terms of embracing health information technology (IT) for obvious reasons. Hospitals understand health IT as a means to improve the business of health care, create a more efficient system across departments, and manage the financial side of hospital operations.  EHR systems are an extension of good business. “EHR can create a great deal of efficiency,” observes Loughlin. For a small practice, the adoption of certain kinds of health IT is considered superfluous to efficient business. However, small practices can’t afford to pass up on incentives and run into future penalties.

2014 is the year of Stage 2 Meaningful Use and HIE; meanwhile, 2012 and 2013 represent a period of necessary growth for small practices.

Related Articles:

• EHR adoption depends on age group, practice size and setting, and specialty
• Why can’t rural health clinics receive EHR Medicare incentives?
• Wide River TEC reaches REC milestone
• Getting CAHs to attest to meaningful use
• Part I: The go-to resource for meaningful use in NH
• Part II: The go-to resource for meaningful use in NH

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