FPs Stack Up Well in Implementing EHRs

Managing Expectations Key to Reaping Incentive Payments

April 01, 2011 05:45 pm David Mitchell

As the medical community continues its trek into the age of health information technology -- spurred, in no small part, by federal incentives to adopt electronic health record, or EHR, systems, along with the threat of financial reprisals for resisting -- family physicians are further along the road than physicians in other specialties. And those federal incentives for adoption and comprehensive utilization could very well keep family docs on the cutting edge.

[FPs Stack Up Well in Implementing EHRs]

According to the National Ambulatory Medical Care Survey(www.cdc.gov) conducted in 2010 by the CDC's National Center for Health Statistics, 48.3 percent of all office-based physicians were using an EHR at some level in 2009. Meanwhile, use of EHRs among board-certified family physicians increased from 37 percent in 2006 to 55 percent in 2009, according to an article(www.jabfm.org) in the March/April 2011 Journal of the American Board of Family Medicine.

Also in 2009, 52.9 percent of members who responded to an AAFP survey indicated they were using an EHR in their practice.

"I would say the biggest reason (for the higher EHR adoption rate among FPs) is AAFP leadership around the issue," said Terry McGeeney, M.D., M.B.A., president and CEO of TransforMED, the AAFP's wholly owned subsidiary that specializes in practice redesign. "The AAFP had very consistent messaging early that EHRs are critically important to the future of the specialty."

In addition, said McGeeney, whereas many primary care physicians acquire practice management systems with their EHRs, subspecialists are more likely to outsource management of their billing and collections.

FPM Fields EHR Satisfaction Survey

The editors of Family Practice Management are encouraging members to take a survey about satisfaction with their specific electronic health record, or EHR, systems.

The user-satisfaction survey is open to all AAFP members who use commercial EHRs. A higher response rate will result in reports on more EHR systems and a more complete report. The survey takes only about five minutes to complete.

FPM editors will use the data collected to publish product-specific results in an upcoming issue of FPM.

HITECH Incentives Offer Motivation

The Health Information Technology for Economic and Clinical Health, or HITECH, Act, which was part of the American Recovery and Reinvestment Act of 2009, included incentive payments to physicians and hospitals participating in Medicare and Medicaid if those providers adopt EHRs and achieve meaningful use of the systems.

According to a study(content.healthaffairs.org) (abstract) recently published in Health Affairs that drew from physicians' 2007-08 Medicare and Medicaid data, more than 80 percent of office-based physicians could qualify for the HITECH incentives if they meet federally designated meaningful use criteria. However, the study pointed out that although more than 90 percent of office-based family physicians, internists and general practitioners could qualify for the incentives based on the number of Medicare and Medicaid patients they see, less than two-thirds of pediatricians, OB-Gyns and psychiatrists may qualify.

The study also noted that the vast majority of physicians -- including family docs -- are falling well short of meaningful use standards. Although roughly 16 percent of family physicians, internists, general practitioners, pediatricians and OB-Gyns were using a basic EHR during the period covered by the study -- meaning their systems captured information components such as current and previous relevant diagnoses, clinical notes, lab and imaging test results, and prescriptions -- those basic functions are not enough to meet criteria for meaningful use.

Only 4 percent of physicians were estimated to have more extensive systems, which were described as "fully functional" EHRs, but these, too, fell short of meaningful use standards.

The incentives(www.cms.gov) for meeting those lofty standards -- which can total as much as $44,000 for physicians who participate in the Medicare incentive program during a five-year period or as much as $63,750 for those who participate in the Medicaid incentive program during a six-year period -- can help offset the cost of investing in the technology.

According to Jason Mitchell, M.D., assistant director of the AAFP's Center for Health IT, the average cost of implementing an EHR is $40,000 per physician.

Planning Ahead Is Key to Success

But physicians need to look beyond cost when planning to implement an EHR system, said McGeeney.

"We often see that it is not price -- but concern about operational inefficiencies, loss of data, reluctance to change processes -- that is the hurdle," he said. "Concern about price is often as much about a lack of education in buying the right technology for the size of the practice and not looking at the return on investment that includes such costs as those associated with pulling charts, acting on them and refiling.

"After implementation, the biggest challenge is continued process change and adaptation," he added. "It is really about change management and process change, which is always uncomfortable for physicians and needs to be supported."

Estimated failure rates for EHR implementation range from one-third to one-half, according to Mitchell.

"There's a fairly significant failure rate if you don't head into this with the proper expectations and resources," he said.

FPs can maximize their chances of success by exercising due diligence before buying an EHR system and planning extensively before implementing that system, McGeeney advised.

"It is critically important that the practice purchase an EHR that fits its needs and practice style," he said. "It is said that to use an EHR effectively, it should touch every aspect of a practice. Many physicians look at it only as a mechanism to electronically document the patient encounter and do not see the true value.

"If processes do not change in a thoughtful manner, the practice just ends up doing bad things faster," said McGeeney.