Abstract
BackgroundAdoption of EHRs by U.S. ambulatory practices has been slow despite the perceived benefits of their use. Most evaluations of EHR implementations in the literature apply to large practice settings. While there are similarities relating to EHR implementation in large and small practice settings, the authors argue that scale is an important differentiator. Focusing on small ambulatory practices, this paper outlines the benefits and barriers to EHR use in this setting, and provides a "field guide" for these practices to facilitate successful EHR implementation.DiscussionThe benefits of EHRs in ambulatory practices include improved patient care and office efficiency, and potential financial benefits. Barriers to EHRs include costs; lack of standardization of EHR products and the design of vendor systems for large practice environments; resistance to change; initial difficulty of system use leading to productivity reduction; and perceived accrual of benefits to society and payers rather than providers. The authors stress the need for developing a flexible change management strategy when introducing EHRs that is relevant to the small practice environment; the strategy should acknowledge the importance of relationship management and the role of individual staff members in helping the entire staff to manage change. Practice staff must create an actionable vision outlining realistic goals for the implementation, and all staff must buy into the project. The authors detail the process of implementing EHRs through several stages: decision, selection, pre-implementation, implementation, and post-implementation. They stress the importance of identifying a champion to serve as an advocate of the value of EHRs and provide direction and encouragement for the project. Other key activities include assessing and redesigning workflow; understanding financial issues; conducting training that is well-timed and meets the needs of practice staff; and evaluating the implementation process.SummaryThe EHR implementation experience depends on a variety of factors including the technology, training, leadership, the change management process, and the individual character of each ambulatory practice environment. Sound processes must support both technical and personnel-related organizational components. Additional research is needed to further refine recommendations for the small physician practice and the nuances of specific medical specialties.
Highlights
Adoption of electronic health records (EHRs) by U.S ambulatory practices has been slow despite the perceived benefits of their use
A 2007 Commonwealth Fund report recommended that a one percent assessment on insurance premiums and Medicare outlays should be used to finance the acceleration of provider adoption of health information technology (HIT) that encompassed decision support capacity and enabled the sharing of patient health information across sites of care [5]
The second purpose of this paper is to provide a basic guide for facilitating successful EHR implementation in smaller ambulatory practice settings for physicians and those supporting the practices
Summary
Adoption of EHRs by U.S ambulatory practices has been slow despite the perceived benefits of their use. Focusing on small ambulatory practices, this paper outlines the benefits and barriers to EHR use in this setting, and provides a "field guide" for these practices to facilitate successful EHR implementation. The rate of use of information systems for clinical care in small physician practices in the U.S in 2006 was estimated to be within the range of 14% to 25% [1,2]. The California HealthCare Foundation reported that small or solo practices or community-based clinics are far less likely to implement EHRs and electronic prescribing than physicians working in large practices [6]
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