Why haven’t you and your partners adopted EMR?
Page: We recently converted to a new practice management software system, and we want to have all systems working properly and efficiently before implementing an EMR system. All options and processes must be reviewed before we implement EMR for the practice. These options include voice-activation software integrated with the EMR, practice process changes, and practice workflow adaptation.
VanMeter: For our independent practice, with five locations, the initial cost of hardware and software is clearly an early concern. With a rapidly changing hardware environment, once a decision is made, the technology that was proposed may be obsolete before being implemented. Then the continuing cost of hardware and software upgrades—read: “the newest gadget”—and maintenance is also a major budgetary item that we need to consider.
As with most medical practices, our organizational structure is flat. If we were to implement a client-server application, we’d need a systems administrator—and that again increases the cost to the practice. Then we’re faced with the question of how we best utilize this person. Or do we outsource this function? And outsourcing then raises a concern of timely responsiveness to major system problems that may extend downtime, prohibiting the use of your EMR system.
Today, telecommunication costs have plummeted, so the costs of a T-1 line [for high-volume Internet access] and high-speed Internet service are not as onerous as they once were. But a major expense will be to retrofit all our offices (wiring, etc.) to adapt to an electronic environment.
Overall, this is a young industry. I compare it to what we saw with video-tape technology in the 1970s: You had to choose between Beta and VHS formats. Once you made that decision, you paid a premium for the early technology.
Similarly, no one knows which EMR system will prevail over time. The early players are paying for the cost of startup and research and development. As time goes on, we all know that costs should fall—significantly.
Another concern that we have is the long-term viability of the software vendor. Until recently, most applications were developed by small independent firms. Their product was a proprietary one—for which only they have the code and only they could manipulate. If that vendor goes out of business, we’d be left to find a new system, and incur all those implementation costs again.
I think we’ll see a major consolidation of vendors over the next several years— one that leaves only premier vendors with superior products in the market.
As a final concern, and perhaps most important, the role of the federal government weighs heavily on our minds. We believe that, very soon, Washington will mandate EMR and how they are to be accomplished. We also believe that the feds will require integration of medical practice EMR systems with the systems of hospitals, third-party payers, and other medical providers. Our belief is that money may become available—like the funding recently authorized for hospitals to subsidize software and maintenance costs—that will defray the cost of implementing an EMR system in our practice. When this comes to pass, we don’t want to have to reinvent the wheel.
What economic barriers does EMR present?
Page: The economic barrier is really not capital expense but the perception that, for a significant period, EMR will require additional time from the medical staff, which reduces the number of patients seen by a physician and, therefore, affects compensation.”
VanMeter: It seems that, when you purchase an EMR system, you have to comply with the way it works. The tail wags the dog. More flexibility in how a system works at the level of the individual provider would make it more economical in terms of productivity.
What features are lacking that causes you to delay adoption?
Page: Successful voice activation and complete handwriting functionality from laptop to chart.
Are there political barriers to adoption?
Page: EMR represents change, and this is always difficult for larger physician groups. Some physicians are still hesitant to make the transition to an EMR from a paper chart, even when the benefit of EMR is proven. Others are hesitant because they are not acclimated to using a computer in the setting of a patient visit.
VanMeter: First, and foremost, the buy-in of all physicians in a group is needed. In my group of 16 physicians and two nurse practitioners, this is tough—especially when age ranges from 31 to 67 years (four in their 60s and close to retirement). Finding consensus on a system will be difficult for that reason alone.