Become an informed tech shopper

The fear that many physicians at small practices have about health information technology isn't that they're afraid of computers. It's that they're afraid they will buy the wrong thing, wasting tens of thousands of dollars on a system that makes their practice less efficient than it was when everything was done on paper.

The result: Solo and other small practices lag behind their larger peers in adopting electronic medical records. SK&A, a marketing research firm in Irvine, Calif., released a survey of more than a quarter of a million medical sites that found as of July 2011, only about 30% of solo practices used EMRs, as did slightly more than 40% of two-physician practices. But for those with 26 or more doctors, the percentage was slightly more than 75%.

Many small practices have opted out of the anxiety of selecting a system, but they also are losing out on a potential $44,000 over five years from the Medicare program or up to $63,750 over six years from Medicaid under federal meaningful use incentives. Over time, those incentives will disappear, but not the expectations that practices will switch to an EMR.

How can a practice purchase technology without the fear of making an expensive mistake? Technology experts uniformly say the key is having a practice take time to map its office routines and patient flow. Then the practice should figure out, as it checks out new systems, how a system would end up changing those office routines and patient flow. By knowing what inefficiencies need to be solved before buying a system, it's much easier for a small practice to pinpoint what it needs, and avoid a costly error.

However, a small practice might not have the time or expertise to accomplish those tasks. Vendors will offer to help, but physicians have told the American Medical Association that true, independent sources of such information are wanting.

The AMA and the TransforMED subsidiary of the American Academy of Family Physicians have developed three online educational tutorials that any practice -- whether or not its physicians are AMA members -- can use to better implement health information technology, before a system is even purchased (link).

The video tutorials, about seven to 10 minutes each, cover technologies involving electronic prescribing, pre-visit planning and point-of-care documentation, all of which can be part of an EMR system. Each of the tutorials is certified for continuing medical education credit. (The AMA sells EMRs as part of its Amagine online portal. Amagine is not involved in the tutorials.)

Videos include animated, side-by-side comparisons of what work flow might look like in a small practice before buying health IT, and what it might look like afterward. Diagrams are available to help physicians map their office routines.

The tutorials also contain links to other information physicians might want to consult, so they and their staffs feel comfortable sitting down with a pencil and a sheet of paper to map out what their work flows look like. That way, when a vendor arrives, the practice can ask more informed questions that can give physicians more comfort that they are buying the right systems.

In May 2011, the AMA included a work flow "needs assessment" as part of another, six-part CME series that it still offers online (link).

That series gives step-by-step instructions to physicians on choosing, purchasing and implementing technology. The newest tutorials expand upon that needs assessment by giving physicians even more details on analyzing their work flow.

Physicians can use both series to help their practices analyze what they want technology to do, and then study how best to shop for it, how to implement it, and what to do post-implementation to ensure that the practice can get meaningful use bonuses.

Physicians at small practices are always going to feel some trepidation when they make the large, workplace-altering purchase of health information technology. But they can be more confident of a good outcome if the first investment they make is the time spent understanding what they need and how to get it.