The best technology and best of intentions may not be enough in the world of electronic medical records (EMR) for a clinic in the Southern U.S.
The new EMR system at Harbin Clinic has the strong support of its CEO, board of directors and chief medical officer. Its technology can improve patient outcomes while saving physicians money. But cultural issues, including resistance from some of Harbin's physicians, have stretched the implementation from two and a half years to four.
Advocates of EMR contend that melding these systems with the work processes of physicians, nurses and administrators can dramatically improve the quality of patient care and cut waste out of health care costs. For instance, by using an EMR system, a doctor can view a patient's entire medical history, use a rules-based engine to pinpoint potentially harmful drug interactions and receive suggestions for new tests and medications.
Studies have shown that the use of EMR systems can help reduce medical errors, including misdiagnoses and unintentionally harmful prescriptions, leading to fewer accidental patient deaths.
But to date, EMR adoption has been a big challenge in the health care industry. Rome, Ga.-based Harbin Clinic is a case in point.
Georgia's largest privately owned, multispecialty medical clinic has 135 physicians spread out across 20 locations in northwest Georgia and northeast Alabama. With 33 different medical specialties under its roof, ranging from endocrinology to ophthalmology, Harbin has had a tough time getting various specialists to adapt their work processes to accommodate the EMR system from Chicago-based Allscripts LLC that it's installing.
Indeed, the cultural and work process differences among these specialists have made the EMR implementation "more difficult than I would have imagined," says Harbin CIO Tom Fricks.
However, primary care physicians at the clinic immediately embraced the EMR system, since they found it easier and cheaper to key in patient information than to pay a third party to transcribe dictation, says Fricks.
But high-end specialists, such as cardiologists, have been considerably more resistant to learning and using the Allscripts TouchWorks EMR system, says Fricks. Cardiologists "don't want aggravation in their lives," he explains.
Despite strong support of the EMR system from Harbin's CEO, the board of directors and its chief medical officer (who happens to be a cardiologist), the project has dragged on.
"It's been a long process for us," says Fricks of the estimated US$2.5 million to $3 million effort, which Harbin expects to complete in June.
The clinic's difficulty implementing EMR is not unusual. According to a study released last July by the National Center for Health Statistics in Hyattsville, Md., just 9.3 per cent of all physicians in the U.S. use complete EMR systems.
"It's a field strewn with the carcasses of broken promises," says Mark Frisse, professor of biomedical informatics at Vanderbilt University in Nashville.
That's why Medicare and a handful of health insurers, such as Blue Cross and Blue Shield of Massachusetts Inc., have begun to sweeten the deal for doctors by offering "pay for performance" incentives that are aimed, in part, at enticing physicians to adopt and use EMR systems to improve their quality of care.
Pain point
But physician resistance isn't the whole problem. Cost constraints, the lack of dedicated IT staffers at smaller physician groups and the disruptive impact that EMR installations can have on a health care organization have also limited adoption rates.
Installing a full-blown EMR system at a large hospital can cost up to a few hundred million dollars, says Frisse. That's a big chunk of change, especially for cash-strapped hospitals.
Plus, roughly 3,000 of the nation's 5,000 hospitals are not-for-profit institutions, notes Eric Brown, an analyst at Forrester Research Inc. in Cambridge, Mass. Unlike for-profit hospitals, those organizations don't have shareholders "clamouring for profits" through improved technology, says Brown, so there's less pressure to invest in EMR systems.
EMR investments can be even more daunting for small physician practices of, say, two to six doctors. The average cost per physician for EMR system evaluation, installation and training runs about $40,000, says John Halamka, CIO at Beth Israel Deaconess Medical Center in Boston. He is also chairman of the Healthcare Information Technology Standards Panel, an ANSI-backed initiative that's aimed at facilitating interoperability among health care applications.
Another problem is that the primary benefits that EMR systems generate - higher-quality care and improved patient outcomes - are skewed toward fattening health insurers' profits and helping patients, says Halamka.
"The individual who receives the least economic value is the physician," says J.P. Little, chief operating officer and acting CEO at RxHub LLC, a nationwide information exchange in St. Paul, Minn., that connects physicians, patients, pharmacies and pharmacy benefit managers.
That's where pay-for-performance incentives may tip the scale, Little says. "If a doctor got a bonus of ten or twenty grand to improve quality of care, they're going to adopt the technology," he says.
Next page: Barriers to EMR adoption
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