Fighting through the EHR jungle

For physicians, the pressure to adopt electronic health records comes from every conceivable direction.

President Bush wants an EHR for every American by 2014¹ , and Medicare² and private payers³ are nudging doctors to make that happen. One Massachusetts health system is even tougher. It told its participating primary care doctors to commit to EHRs by January 1, 2008, or face expulsion from its network (13 are scheduled to get the boot).⁴ And patients want their physicians to be as automated as their banks, according to survey after survey. ^5,6

Yet the most powerful motivation to adopt an EHR may be the promise of a more efficient practice. If all goes well, you and your staff will no longer go crazy looking for lost charts or wasting time on the telephone. If nothing else, an EHR could lower your stress level.

Of course, the dig-in-the-heels rebellion against EHRs remains strong, and for some understandable reasons. Too costly. Too confusing. Staff hates it. Slows things down instead of speeding them up.

Overcoming such barriers, which we address in the box on page 62, is a key to success-but it's far from the only one. To get the most from your EHR, you must make crucial decisions about the kind of system to buy, the level of technological cost and complexity you're willing to tolerate, and how your EHR will mesh with your practice management software. The effectiveness of your EHR also depends on connecting it to the computer systems of labs, pharmacies, and hospitals, which requires planning on your part. So before you buy, consider these four important issues.

How important is EHR certification?

While most commercially available systems do most of the same things, there's enough variability from product to product to raise the question: What are the essential features of an EHR?

The Bush administration thinks that's a question worth answering. It wants to ensure that if the government and the private sector subsidize EHRs for doctors, they don't end up investing in products with limited features. Accordingly, the Department of Health and Human Services has contracted with a nonprofit industry group called the Certification Commission for Healthcare Information Technology to develop basic criteria for EHRs and certify products that meet them.⁷

For office-based EHRs, CCHIT has promulgated 247 criteria for functionality, security, and interoperability. Functionality criteria include the ability to display a problem list, create a prescription, and capture vital signs as searchable data. To keep this data confidential as mandated by HIPAA, CCHIT security standards require an EHR to create an audit trail. Interoperability is just as critical, because EHRs are lame if they can't swap data with other computer systems. Accordingly, certified EHRs must be able to electronically import lab results and transmit prescriptions. Next year, the organization plans to start certifying EHRs on the basis of exchanging medical summaries with EHRs from other vendors.

As of January 16, 90 programs had received CCHIT certification. Should you limit your EHR shopping list to these products?

To be sure, the stamp of approval carries a lot of weight, given the breadth of CCHIT membership, which includes physicians; executives from the hospital, insurance, and software industries; and independent IT experts. However, you shouldn't necessarily rule out EHRs from small vendors who are deterred from seeking certification by a $28,000 application fee. Some of these products-basic but effective-are geared to small practices that can't afford more sophisticated systems. As these less expensive programs gain market share, they, too, may seek certification.

Groups of 10 or more doctors, however, should pay closer attention to CCHIT certification, since they'll need more sophisticated systems than small practices and, presumably, are able to afford them. What's more, EHR certification may become imperative. A Medicare pilot project will reward up to 1,200 practices that use EHRs to reach certain quality goals, but only if their systems bear the CCHIT imprimatur.⁸ If this becomes the norm for physician compensation, you could forfeit money by buying a noncertified EHR.