Training, preparation are key to smooth EHR adoption

Daniel Goodman, MD, thinks his practice's adoption of electronic health records (EHRs) has gone about as smoothly as he could have expected. The reasons? Training, preparation, and a willingness to tailor the system to his needs.

A solo internal medicine practitioner for 25 years, Goodman leases offices in a small medical complex located in a commercial district of Dunwoody, Georgia, a suburb of Atlanta. From there he sees about 30 patients per day out of a patient base of approximately 3,500.

Although initially reluctant to adopt an EHR system, he changed his mind, he says, because "it seems like with the [government's] bonuses and penalties, your choice is either to go on EHR or retire, and I'm not ready to retire at 56."

Goodman estimates he has spent $12,000 on expenses associated with the system, including four desktop and three laptop computers, three printers, and establishing a secure, in-house network. In addition, he has paid $5,000 to hire an information technology firm to maintain the system.

"I had to spend more than I expected for the hard costs, but it had to be spent," he says. "You can't go into this with underpowered or incorrect equipment." He says he expects to recoup much of that investment by qualifying for meaningful use.

Goodman found the system's templates for recording a patient's history of present illness (HPI) restrictive, so in their place he dictates HPIs using Dragon voice recognition software, which is compatible with MedNet's EHR. "I only want in there the information I want to put in," he says.

In the first month after going live, using the EHR reduced his practice's productivity. "Now we're back to seeing the same number of people as before, but if we get really busy, we can't squeeze in more people like we used to do," he says. "And I'm working an hour longer most days."

Looking back on his practice's adoption experience thus far, Goodman is generally satisfied. "I think we did a good job of installing, training, and getting ourselves prepared. I can't think of anything I'd have done differently," he says.

That's not to say there haven't been bumps and complaints along the way. "A certain degree of frustration comes with the territory. There will always be things that don't work the way I think they should work or my nurse or front office people think they should work. I remind them there's not some perfect system out there. If there was a perfect system, everyone would have it."