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Small Practices Are Big on Success with EMRs


Bigger is better, right? Well, not always. And especially not when it comes to medical practices and success with electronic medical records.

Bigger is better, right? Well, not always. And especially not when it comes to medical practices and success with electronic medical records.

According to the results of the 2015 Medical Economics survey on health information technology, in many respects small primary care practices lead the way when it comes to successful EMR adoption.

James Aram, MD, is a solo practitioner with Brunswick Family Practice in Troy, NY, is not surprised by the survey results.

“We adapted to the training rather quickly, partly because there were fewer of us that needed to be trained,” Aram says. “But we were well motivated, and everybody was on board. I think that was a big factor.”

Keeping It Small

For Brunswick Family Practice, “small” is the operative word. Aram explains that the size of the practice enables quick decision-making without having to spend time working through committees.

“We’re at an advantage in that sense,” Aram says. “We can turn at a point quickly. We don’t have to involve a lot of other people and layers and layers of bureaucracy in order to make changes regarding how we want to operate and how the workflow should go at the office.”

It helped that Aram kept it small when selected an EMR vendor. The practice steered clear of large national vendors and, being able to vet some programs through the New York State Medical Society, selected someone local.

“We made the right decision,” he says. “Mimi (office manager Mimi Grandjean) can call them up and say I need this or that, and in a day or two they’ll write a report or a script that helps us meet meaningful use requirements, or other requirements to be a patient-centered medical home.”

Aram doesn’t believe that level of quick service is present when working with some of the larger vendors, where layers of personnel have to be permeated before reaching a programmer. He believes his practice is on an equal playing field with larger EMRs in terms of versatility and functionality.

“We’re also part of something called CPCI, which is a comprehensive patient care initiative, which is something that is taking place in seven different places throughout the United States,” Aram says. “It’s our best initiative. And I think we’ve also been able to satisfy their requirements as well. So, you know, I think for us, it’s a positive experience.”

Motivation and Mindset

Aram says that as a small practice, he and his staff were well motivated to engage with a vendor and get the ball rolling. That’s because, in part, incentive money and the penalties for not attesting to meaningful use can have a more significant financial impact on a smaller practice.

“It’s survival mode that you’re in,” he explains. “We’ve got more skin in the game. If we don't do this, nobody is going to do this for us. We have to take the initiative to create this environment—the EMR environment—that will allow us to move forward with all the pay-for-performance and other value-based incentives that are coming along.”

Practice office manager Grandjean says it’s a mindset, and being willing to adapt to new ways of doing business in order to survive. That’s where she credits working with a small, local vendor.

“When I call out there, I know exactly whom I have to speak with to get a problem resolved,” she explains. “It’s not like there’s 50 people and you don’t know who’s going to phone you back.

Best Practices

Aram says having the electronic medical record enables the practice to run specific reports to meet the requirements of meaningful use. And it all starts with selecting the right vendor to work with.

“If you’re a pretty standard physician and not trained in EMRs, you may not know what the functionality is and how it will impact your workflows,” Aram says. “Picking the right EMR can be a problem.”

He points to other practices that selected an EMR that is not as robust as the one his practice employs, and as a result those practices are not fully integrated. He says having a resource to help evaluate EMR options is essential.

It’s also critical for practices to assess their own needs and understand their workflows in order to select an EMR that’s a more natural fit, rather than adapting the practice’s workflow to the EMR.

“There’s going to be some pain no matter what you do,” he says. “But talk to other people who already have EMRs in their community and see who is happiest with their choice. Because if you can minimize the pain and improve the existing workflows, that will help.”

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