Look before you leap: small and mid-size physician practices can eradicate EMR challenges with homework and planning

Health Management Technology, May, 2005 by Richard R. Rogoski

The Bush Administration is pushing for their adoption. Hospitals are rolling them out in greater numbers. More large physician practices and independent practice associations have become adopters.

But what about small and mid-sized physician practices? Aside from cost concerns, what are the challenges and obstacles they face in considering electronic medical records (EMRs) and electronic health records (EHRs) for daily use? Solo and small independent practices dominate the U.S. landscape. For EMRs to become SOP, they must be affordable, installable and usable by the majority of U.S. physician offices.

"I realized that to document properly would take an EMR," says Michael Dotti, M.D., owner of North Country Family Practice in Grapevine, Texas. "An EMR would enable us to keep better track of data. We could treat patients better because information would not fall between the cracks."

Similar gains in efficiencies have been reported by Les Wilson, M.D., who, with his doctor-wife Vicki, own and operate Wilson Family Medicine in Tallahassee, Fla. "We are more thoroughly documenting patient encounters and documenting at the point of care while we are in the room with them," he says. "We have been surprised at how much more efficient we are with internal communications among staff, nurses and providers."

Debbie Eddlestone, chief operating officer of Stern Cardiovascular Center in Germantown, Tenn., says her practice began implementing an EMR module by module.

By interfacing the lab results module with an existing laboratory information system, physicians soon discovered that the information they wanted was just a point-and-click away. "We entered lab results for patients into the system, and when doctors wanted them, they realized how quickly they could get the results they wanted," she says.

Still, the decision to purchase an EMR was not made overnight. In fact, all three practices carefully weighed their options and wrestled with questions related to implementation, tech support and maintenance.

Weighing the Options

For Drs. Les and Vicki Wilson, being able to purchase an EMR was a dream come true after years of being a dream deferred. Until October 2002, both were manning an outpatient clinic and were employees of Tallahassee Regional Hospital. They had already considered purchasing an EMR for the clinic, so when they later established their own private practice, they saw it as a perfect opportunity.

The Wilsons narrowed the field to four vendors. The HealthMatics EMR from Cary, N.C.-based [A.sup.4] Health Systems consistently emerged the frontrunner, largely because it could easily be interfaced with the Wilson's existing practice management (PM) system. But then, support for the PM became an issue from the vendor involved. Wilson Family Medicine is a small practice consisting of two physicians, one nurse practitioner, two nurses, an office manager, an operations manager, three receptionists and 6,000 active patients; getting the necessary technical support from a large vendor isn't always easy.

Rather than interface the new EMR with the old PM system, the Wilsons secured a bank loan, opted for single-source status and purchased both the HealthMatics EMR and the Ntierprise Practice Management system from [A.sup.4] Health. "When you choose an EMR, you buy into a relationship that's long-term," Les Wilson says.

Since installing the new PM system in July 2004 and the EMR in October 2004, the practice has had few technical glitches. Admittedly, being computer literate has helped. "If we're at home on the VPN and it gets disconnected, I now know how to get into the server and reestablish the connection," Les Wilson says.

Critical Choice Factors

Having someone on staff with a basic knowledge of computer hardware and software is invaluable for smaller practices, says Dwight Rector, practice administrator at North Country Family Practice.

Both Rector and Dotti were already familiar with the computer-based patient record system (CPR) and the practice management system developed by Misys Healthcare Systems in Raleigh, N.C. When it came to purchasing an EMR for the practice, Misys got the nod. Yet, Rector says vendor support is only part of the equation. "Practice administrators need some computer fluency and to be amenable to EMRs. Misys has great support, but a small practice can't rely strictly on vendor support. You must have someone in the office who is in charge of implementation, and you have to learn to troubleshoot."

Running a practice with three physicians and three nurse practitioners who see more than 130 patients a day, Dotti had been contemplating buying an EMR for five years before he finally made the purchase. With a number of vendors offering similar products, he wanted to be sure that the vendor he chose would still be in business after another five years.

Eddlestone says her decision to purchase the TouchWorks electronic health record by Chicago-based Allscripts Healthcare Solutions was driven by three factors: flexibility, functionality and support. Of the three, flexibility became the deciding factor. "We can implement one module at a time, one physician at a time. We looked at several vendors' products, but we didn't want the 'do or die, flip a switch and everybody's on' kind of application," she says.