EMR Implementation Is about Numbers and Mindset

The numbers don’t paint an inviting picture, indicating that physician practices that have integrated electronic medical records into their daily workflow are in the minority. From concerns over the cost to skepticism over the benefits, physicians have found myriad reasons not to switch to electronic records. But those who have switched tell a different story.

Greg Oliver, DO, implemented an Allscripts electronic health record when he opened the doors to Indianapolis-based Oliver Family Healthcare in 2003. An early adopter, Oliver says when the practice went live with new practice management and electronic health record systems, it was the best thing that happened to his practice. “In 26 years of practice, the last six-and-one-half have been the best, most exciting and most profitable for me.”

Analyzing costs

Oliver says that too often physicians focus on this large outlay of cash and are scared off. He recalls that the new electronic health record system, complete with hardware and training, was approximately $60,000. “For a small practice with one doctor, that’s a large chunk.”

But in analyzing expenses, he realized he was already spending $39,000 a year on chart management and transcription costs—a savings he would immediately realize by implementing the electronic health record. Factor in the $35,000 in salary and benefits of an office worker who quit because she didn’t feel comfortable working with computers, and the new system paid for itself during its first week.

“We took the chart room and turned it into more front office space,” Oliver explains. “When I think of the benefits—our efficiencies, our ability to see additional patients—all the things we’ve been able to do have dramatically increased our profitability.”

That’s putting it mildly. Oliver reports that the practice has experienced a reduction in costs of up to $158,000 per year, while increasing revenue by approximately 25 percent per year over the last five years. But the key to success, he says, wasn’t just adopting an electronic health record, it was the attitude and mindset that went with it.

“I think physicians need the mindset that ‘I’m in charge here. This is my practice, and I’m going to take ownership of the record,’” Oliver says. “The doctors who do that look at the electronic health record as a jump ahead in light years compared to what they were doing with paper charts.”

Dive in, or wade in

New York-based Allergy, Asthma, Immunology of Rochester, PC, rolled out a new electronic medical record system by Sequel Systems in 2007. Since then, the practice has achieved a fully paperless environment and total savings of more than $110,000. Peter Deane, MD, principal, says one of the keys to success was implementing the EMR gradually over time.

“It allowed us to [changeover] without affecting our productivity in any significant way,” Deane explains. “Any practice that does a fairly abrupt implementation has to cut back it’s productivity significantly—cut back seeing people by 25 to 50 percent for some period of time. That’s a giant shift, and potentially disasterous for a private practice in financial terms.”

Deane says it may sound shocking, but the practice did not put a lot of time into weighing the cost of implementing the EMR versus increased productivity prior to the changeover. The reason, he says, is that if your practice needs to make the change, it needs to make the change.

What is important, he points out, is the price of the system, and being aware of what efficiencies can be gained from the system as soon as possible. “You just need to be conscious for any opportunity for return on investment, and implement it as soon as you can.”

Funding available

At present, only about 13 percent of small physician offices use electronic health records. That should change over the next several years, in part because the American Recovery and Reinvestment Act will provide physicians with $44,000 in Medicare reimbursements over five years for implementing an EHR system and demonstrating meaningful use. However, those reimbursements don’t begin until 2011. But there is help for the willing.

Ingenix, a UnitedHealth Group company, recently introduced a package that includes interest-free financing, health information technology services, and performance guarantees to help physicians integrate HIT into their practices. Cost is a physician’s top concern when considering EHRs, and the Ingenix program enables physicians to implement Ingenix CareTracker EHR, a low-cost, full-functioning electronic health record, with no out-of-pocket costs and no payments until 2011. Qualifying physicians can receive an interest-free loan from OptumHealth Bank to license and implement the EHR.

However, taking any action without the proper mindset may be fruitless.

“If you [implement an EHR] because someone says you have to, that’s not a great plan,” Oliver says. “The plan is, how can we find a system that enhances what we do every day, and allows us to become better at what we do? And if you implement using that mindset, your plan will expand monthly and yearly.”