Medical Economics EHR Best Practices Study examines productivity declines when implementing an EHR

It's like going back to medical school, says Andrew Garner, MD, of Glenn Falls, New York.

He is referring to the learning curve and pace associated with the implementation of his practice's electronic health record (EHR) system. And he is not alone.

In a new Medical Economics EHR Best Practices Study survey, 63% of survey participants report experiencing disruption to practice, whereas three-fourths of study respondents say it is taking excessive physician and staff time to implement.

According to George G. Ellis Jr., MD, a Medical Economics adviser and study participant from Boardman, Ohio, doctors starting to implement their EHR systems should expect major delays and late nights, especially for solo practices with limited support.

The "go-live" stage is one of the most challenging aspects to the implementation, Ellis adds, because physicians are faced with integrating records and trying to achieve a level of functionality with the system. At the same time, they are learning how to use it while examining patients, diagnosing conditions, and treating them. Workflow adjustments add new complications to an already complicated process.

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Much of the disruptions to the standard practice flow, Ellis suggests, are being caused by the inordinate amount of time it takes to enter new demographic information and patient data into the systems. In essence, doctors are populating medical records from scratch. And as part of the process, they need to verify insurance eligibility; document problem lists, family history, social history, and surgical history; and update medications lists, to name a few tasks. All of it saps time out of the schedule.

And then there are billing and coding challenges. In the first week, 15 problematic claims emerged for Ellis. And although the vendor of his system, Athena, helped him through the process, it took more time out of a schedule that has to be filled to capacity to make the practice economically viable.

EHR Implementation Checklist

Although experts say that you can anticipate a 30% decline in overall productivity, Ellis contends that the number is higher for solo practitioners who are faced with huge challenges simply due to limited support.

In the Medical Economics study, participants documented some of those challenges. According to the results, the median number of total patient visits declined from initial surveys conducted in late March. In fact, the survey notes a median drop from 100 patient visits to 60 patient visits. Although 30 physicians are participating in the study, 23 were sampled in this survey.

When it comes to Ellis' experience, the go-live date was all about trying to smooth over the patient experience.

"Patients had a really tough time understanding why they had to wait so long," he says. To help ease the process, Ellis suggests talking with patients about the conversion and the benefits they will see as a result, such as accessing their information through a patient portal.

"Some people are understanding; some people are not," Ellis says. "Everybody had to talk to them. I would have to explain over and over why we were changing systems and how we were creating a system online that will be a better experience by accessing a patient portal, which I didn't have in the old system."

But those initial visits extended beyond an hour in some cases, he says. To help, Ellis directed a staff member to float in the waiting room to help patients complete and update their information.

For Ellis, his over-time "went through the roof." And other physicians in the study are reporting that costs associated with this implementation for things such as computers, technical support, Internet connections, and more.

According to the Medical Economics EHR Best Practices Study, expenses associated with the implementation (separate from the costs of the system) jumped from $3,121 in the March 31 survey to $5,373 in the May 29 survey.

The survey also denotes progress in the study participant's work toward meaningful use. Thirty-five percent of study participants report improvements toward meaningful use, and another 65% saw no change.

Other metrics:
• Practice productivity and costs worsened for 39% of survey respondents.
• No change in the quality of patient care was reported by 78% of participants.
• 39% noted improvement in information storage capabilities.
• 82% said no changes occurred in communication with patients.

According to the Center for Health IT of the American Academy of Family Physicians, practices should concentrate on implementing the system for the staff and office first-and the physicians second. The center also recommends that providers and staff become familiar with the hardware and software as much as possible before starting to see patients.

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