Tap into proper expertise and support before joining EHR "gold rush"

The federal government's big health information technology push is expected to lead many more practices to adopt electronic health records. But if history is any guide, the push also could lead to more practices ripping the systems out in frustration.

Studies show that up to 30% of practices stop using their systems or even remove them within one year of installation, and experts say there's no doubt that small practices have a harder time adapting to a newly wired practices than do their larger counterparts. But the experts also see some mistakes -- most of which are preventable -- being repeated. There are efforts under way to help ensure that practices that dip in the technology waters don't drown.

Michael Barr, MD, vice president of practice advocacy and improvement for the American College of Physicians, said most Americans receive health care from small primary care physician practices. "So to the extent that we want to really transform health care, we really need to figure out strategies that help these small practices to do what we are asking of them, which is to, over time, implement health information technology and demonstrate meaningful use, according to the current legislation.

"Therein lies the challenge," Dr. Barr said. "Because these are the practices that have the least operating margin to take any kind of hit on productivity or financial implications of the practice [and are] changing to a new model and reinventing themselves while they are still trying to treat patients."

Funding from the American Recovery and Reinvestment Act to encourage physicians to buy and use health IT is anticipated to bring a boost in the number of formalized support networks. But regardless, practices can take advantage of support communities that already exist, experts say.

Brad Tritle, executive director of Arizona Health-e Connection, said caving in to pressure is the wrong reason to adopt an EHR and a mistake he fears more practices will make.

One thing Tritle has tried in Arizona is to get tech-satisfied physicians who not only can articulate the benefits of going electronic but also can share tips and suggestions for a successful implementation. AzHeC, now a public-private organization, was established by the state in 2007 to help promote health IT adoption.

Dr. Barr said "implementation teams" have formed in such states as Massachusetts and New York and have proven successful in helping make EHR adoptions stick. The teams bring together people with experience in different implementation strategies to help others going through it for the first time. Those resources, in many cases, are free to physicians.

In June, Dr. Barr spoke at the board meeting of the National eHealth Collaborative, where he underscored the need for more of these implementation teams, also known as regional health IT extension centers, that could address the unique challenges small practices face. NeHC is a public-private partnership established by the Office of the National Coordinator for Health Information Technology to help build the infrastructure of the National Health Information Network.

Laura Adams, president and CEO of the Rhode Island Quality Institute, said the federal stimulus package included funding for regional extension centers. But these extension centers, or any other informal groups that would like to form an extension center, need to move quickly.

"Financial incentives are frontloaded, so if you miss early years, you've missed a significant amount of your financial incentives. So I do think it will cause a bit of a gold rush," she said.

The regions that make up the extension centers are self-defined, Adams said. Whoever submits the application for funding declares the region.

Local collaboratives already in place can be drawn upon for support, Adams said. "It's really important to leverage [these collaboratives], because they [already] have built relationships."

Where there is no formalized community, Adams suggested that practices seek out other local practices to get information on what to look for not only in system selection but also in a vendor.

"Many people believe that the vendors, currently, are working hard to keep the existing customers happy," Tritle said. "With the incentives kicking in from CMS, there's going to be more sales, and there's going to be more demands of the vendors. Being able to identify the timelines that they should meet -- and managing them to meet those timelines and managing them to be sure they provide all the support that is needed -- is going to be critical."

Tritle said there are "soft costs" built into the incentives that would help cover project management and training. Most vendors offer additional training options. Practices are best served by overestimating the amount of training they will need, he said.

Dr. Barr said choosing the wrong product is a common mistake. The problem also can be perpetuated when practices subscribe to the "big-bang" theory, adopting a system with all functionalities all at once instead of taking it one step at a time, such as starting with electronic prescribing.

Taking the time to identify what steps in a practice's work flow could benefit from automation is a more thoughtful way of adopting, Dr. Barr said. Having an end-goal for each step of the work flow will help practices evaluate systems more effectively.

Despite evidence that small practices have a harder time making adoptions successful, Dr. Barr said there is one big advantage: "Small practices don't have 100 points of veto. If you set the bar at certain levels, you can get changes relatively quickly."

The key is to get the practice the right advisers and financial support to take the risk, Dr. Barr said. "Once they are up and running, they won't go back."