Lessons from the Front Lines of EHR Adoption

May 25, 2010
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Getting physicians wired still faces tough hurdles.

A World Congress summit in Washington, D.C., May 24-25 brought together a dynamic assortment of health IT leaders on the front lines of the battle to engage physicians around electronic health record (EHR) adoption. CIOs joined with leaders of independent physician associations and regional extension centers to share their experiences on the summit’s topic: “Leveraging the Stimulus Funding to Accelerate EHR Adoption.” One takeaway from the meeting is that even pioneers in getting physicians wired recognize they still have a lot of work to do.

For instance, you might think that installing EHRs in the offices of 100 percent of a 6,000-physician network would be the end of an implementation project. But as Cynthia Bero, chief information officer for Partners Community HealthCare Inc. (PCHI) in Eastern Massachusetts, found out, that was only the first step.

Partners had been working on EHR adoption tied to incentive payments since 2003. But when she began to study how physicians were actually using their EHRs, Bero found she had to create an optimization program that included reporting metrics and additional training. “Adoption is not meaningful use,” she stressed. After product selection and 30 hours of training and work flow analysis, some Partners physicians went right back to using paper, she found. Only after their individual scores on three measures — using the EHR for prescribing, problem lists, and smoking status — were reported within the organization did usage levels rise significantly.

“Creating metrics for EHR use that are clinically important and occur frequently was the key,” she said.

Another common theme at the summit was that health systems are finding that despite their best efforts, reaching the multitude of single-physician offices is their toughest job. “A lot of people we speak to in smaller practices have never heard the term meaningful use,” said Todd Rowland, M.D., executive director of healthLINC, a health information exchange in Southern Indiana that is also a regional extension center (REC) for 1,800 physicians in a tri-state area. “I see a lot of angst, especially among the 50- to 60-year-old crowd,” he added. “I hope we are not unintentionally shoving them out of practice.”

Todd Rothenhaus, M.D., senior vice president and CIO of six-hospital Caritas Christi Health Care System in Massachusetts, noted that part of Caritas’ strategic plan involves recruiting and retaining primary care doctors, and EHR support is seen as key to that effort. Its goal is to implement EHRs for all employed physicians by the end of 2010 and its entire 2,300-physician network before 2012. But only 450 of those doctors are employed by Caritas and about 800 are IPA-affiliated. The rest are in fiercely independent small practices. Thirty-five percent are in single-physician offices, and the adoption rate for that group nationally is around 2 percent. So even with a choice of two EHRs hosted and fully funded by Caritas under the Stark exemption (at a cost of between $20,000 and $45,000 per physician), offering integrated laboratory and radiology results, getting physicians into the pipeline has been difficult. “This is where the real hand-to-hand combat in EHR adoption is taking place,” Rothenhaus said. Caritas currently has 450 providers on the system and is adding two practices per week. One issue mentioned by both Rothenhaus and Rowland is that integration of EHR and practice management systems is much more important to small practices than large ones, and more effort needs to be made to help them with that process. In fact, Rowland said he has found involving practice administrators in the adoption process a key to success. “When we formed a governance structure, we included the practice administrators,” he said. “For me, that has been the secret sauce.”

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