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For ambulatory practices that are already struggling financially, the other challenge lies with the productivity hit encountered during the EMR learning curve. This is another piece of information lost during EMR demos. Physicians cannot see the same number of patients or spend the same amount of time during their typical encounters when they are experiencing an EMR learning curve. Physician offices are often thrown into a complete tailspin when their workflow functions are dramatically changed. The office staff and physicians are quickly thrust into a new way of operating for which they may not have expected. Most vendors draw the line when it comes to helping with office workflow changes. They expect the physician practice to determine what works best in their unique scenario and how best to interface with their individual reference labs and ancillary services.
In the EMR world everything is customized, because of the variety of clinical care services provided, which encompasses primary care, complex specialty care, same day surgery, and other ancillary service inputs. Each practice comes with its own set of requirements, personalities, and eagerness to embrace change.
HELP FOR SMALL PRACTICES
For small physician offices that are trying to meet meaningful use, there are some resources that exist through regional extension centers (REC). REC services include outreach and education, EMR support (working with vendors, helping choose a certified EMR system), and technical assistance in implementing healthcare IT. RECs focus on individual and small practices, including primary care providers, medical practices lacking resources to implement and maintain EMRs, as well as those who provide primary care services in public and critical access hospitals; and community health centers, and other settings that mostly serve those who lack adequate insurance coverage or medical care.
Other resources that are often overlooked by physician practices are local Healthcare Information and Management Systems Society (HIMSS) chapters. The Central/North Florida HIMSS chapter, for example, recently developed an ambulatory IT committee with the purpose of reaching out to the ambulatory market and assisting with the proliferation of healthcare information knowledge and guidance.
Currently, ambulatory IT is truly the last frontier for pushing out technology to the first point of care. There are many challenges in deploying a robust clinical system to small physician offices. However, the time has come for the healthcare IT industry to deliver seamless, cost effective solutions to this market and provide a framework for support for those that need it and for those that may not qualify for REC support. Physicians and staff not familiar with organizations like HIMSS and resources like Healthcare Informatics magazine need to be informed about how to tap into this knowledge base and receive proper guidance in a vendor-neutral environment.
Pete Rivera is consultant manager with Hayes Management Consulting, Newton Center, Mass., and a member of the Healthcare Informatics blogging team, who regularly comments on issues around electronic health record and physician management systems. Healthcare Informatics 2011 October;28(10):42-44
