EMR can equal profit and quality

Why invest in an electronic medical record (EMR) system? That depends on who you ask, saidStephen Waldren, MD, director of American Academy of Family Physicians' (AAFP) Center of HealthInformation Technology. Family physicians invest in EMRs because they expect to streamlinedocumentation and enhance revenue streams. Outsiders, including the federal government and privatepayors, want physicians to invest in EMRs because it will produce higher quality care and lowercosts.

We need to find some way to align those two perspectives," said Dr Waldren at the AAFP 2007Scientific Assembly Thursday in Chicago. "We need to jump from high volume care and payment tovalue-based payment. EMR can help."

About 40% of family physicians have already invested in an EMR compared with approximately40% of physicians overall, Dr. Waldren said. Family physicians have led the way in implementation forat least the past four years, he added.

The downside is that it will take at least until 2016 to reach 80% penetration, even amongfamily physicians. That slow adoption flies in the face of government promises that every Americanwill have an EMR by 2010.

Adoption may take even longer than 2016. A 2007 poll of 4,000 AAFP members found that 37% ofrespondents had fully implemented EMR, 13% were in the process of implementing, and 25% werepreparing. But 25% of respondents said they had no intention of moving to an EMR.

The changing face of healthcare may yet drive that last 25% to accept EMRs. It is clear thatsuccessful medical practices will be the ones that can demonstrate quality and demonstrateimprovement in quality, offer virtual visits and online communications, are rated and reviewedonline, and are interoperable with other parts of the healthcare system.

"This is really about consumer empowerment," Dr. Waldren said. "We need to drive patientsback to us and away from retail clinics. EMRs are one of our most important tools."

But significant barriers remain with cost leading the list, Dr. Waldren said. Physicians alsoneed more best practices, especially those that relate to selecting and implementing an EMR. Mostphysicians have no idea of where to start.

At the same time, many practices do not have the capacity to change. They don't have thecapital to invest in EMR nor the information technology resources. Physicians are also discouragedthat so many decisions relating to EMR and other changes are being made outside the practice setting.And finally, there are few tangible incentives to move to an EMR.

Adopting an EMR is actually the final step in a four-step process, Dr. Waldren said. Theinitial step is to put the practice on a sound financial footing with a plan to stay that way.

Step two is leadership, management, and teamwork that's supported by the entire practice,from the lead physician to the newest office staffer. Step three is to redesign management processesand workflow. The final step is to add healthcare information technology and EMR.

But there is another issue that EMR vendors and advocates outside the medical communityseldom acknowledge: an EMR does not automatically generate quality care. Dr. Waldren reported arecent study that showed paper-based practices can produce better quality measurement results thanEMR-based practices.

Quality is not built into many EMRs not being sold to physicians, he continued. It is up tothe buyer to read the fine print and ensure that the appropriate features are included.

While not recommending specific systems, he advised that buyers insist on four features as anabsolute minimum:

• support for the Continuity of Care Record Standard
• Certification Commission for Healthcare Information Technology 2007 certification
• interoperability and interface with labs
• SureScripts certified

"If you start asking about standards and demanding interoperability, our vendors know how torespond," Dr. Waldren said. "We are developing a more robust set of expectations that we are pushingout to the vendors."