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They’re still uncommon in smaller practices, but change may be in the wind.

Fam Pract Manag. 2004;11(3):13

Electronic medical records (or electronic health records, EHRs) have yet to make their way into more than a small minority of family practices. But little things are beginning to make me think that EHRs may finally be coming into their own.

For one thing, the market seems finally to be maturing. While many small companies and recent start-ups are still out there, a few major vendors with reasonable longevity and reasonably large market shares are emerging at the core of the market. More than that, EHRs are discussed increasingly in terms of functionality rather than feature sets. That is, a certain broad set of features is now more-or-less available in most full-fledged EHR systems, and the questions people ask in comparing one EHR system with another are less, “Can it do X?” and more “How easily can it do X?” and “Does its way of doing X fit with the way we do things in my practice?” (If you need any more proof that the market is maturing, FPM just got its first inquiry letter from a physician interested in writing an article about replacing an aging EHR system.)

AAFP efforts

Certainly the AAFP is putting a lot of energy into promoting the use of EHRs. You have probably heard something about the Academy’s “principled group purchasing agreements” that offer members discounts on several EHRs and related technology from vendors who subscribe to certain principles. Partners who offer EHRs currently include A4 Health Systems, Docs Inc., GE Medical/Centricity, Medplexus, NextGen and Physician Micro Systems Inc. And this is just one of several projects being undertaken by the Academy’s new Center for Health Information Technology. Others that involve EHRs include these:

  • Participating in the development of a new “continuity of care record” designed to provide a standard format for a subset of personal health information that has the potential to be a bridge between otherwise incompatible EHR systems.

  • Leading a pilot program to test the implementation of an EHR system in family physicians’ offices. The software is being provided free of charge to 18 practices to study “barriers and keys to success” in the implementation process.

  • Participating in the Doctor’s Office Quality - Information Technology (DOQ-IT) project, funded by the Centers for Medicare & Medicaid Services. DOQ-IT aims to facilitate the selection and installation of EHR software in primary care offices in an effort to show how an EHR can improve care for patients with a variety of chronic diseases. The project is managed by Lumetra, the California quality improvement organization, in partnership with the AAFP.

What makes DOQ-IT particularly intriguing is its combined focus on information technology and quality improvement. In February, I attended a DOQ-IT “summit meeting” that brought together experts in practice redesign with representatives of several EHR vendors. The resulting dialogue made it clear that EHRs aren’t yet fully in tune with the best thinking on practice redesign – and for good reason. Cost is such a barrier for most practices that return-on-investment tends to loom larger than quality in many decisions to adopt EHRs. And adopting an EHR is enough of an upheaval without the added upheaval of practice redesign. Nevertheless an EHR can help you improve quality.

Learn more

None of this is to say that you’ll have to hurry if you don’t want to be the last kid on your block to have an EHR. There’s still time. But if you haven’t thought seriously about adopting an EHR, this might be the time to start thinking. Naturally, FPM will continue to help. If you’re interested in reading more right now, you might try Electronic Medical Records: Lessons From Small Physician Practices or Electronic Medical Records: A Buyer’s Guide for Small Physician Practices, both published by the California HealthCare Foundation. They’re available for download at At least they can start you thinking.

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