By Ajit Kumar, PhD

Although adoption of EHR systems by healthcare practices has risen steadily in the past 5 years, implementation by solo and small practices trails that of larger medical groups. According to a study published in June of last year in the New England Journal of Medicine (NEJM), only 9% of practices with three or fewer physicians now use an EHR (LOTS OF OPPORTUNITY REMAINING). By way of comparison, 50% of practices with more than 50 physicians have EHRs.

Even though small practices have lower EHR adoption rates, there are compelling reasons for them to implement an EHR. Consider that, according to the survey, provider satisfaction with EHRs is on the rise. High levels of satisfaction indicate that providers get the performance and value they want from their EHRs. Put another way, EHRs now meet cost-benefit expectations.

Moreover, smaller practices can expect more from an EHR, since functions and features once available only on the most expensive systems are migrating ever more rapidly to EHRs designed for small practices. The price-to-functionality ratio continues to shift in favor of small practices, along with improved capacity for customization and better technical support. These developments may account for another significant finding in the survey: 26% of respondents said their practice intends to purchase an EHR system within the next 2 years.

Choosing the Vendor:

Although the range of EHR options for small practices is expanding, it's important that practices devote the necessary time and attention to assessing their unique needs and then deliberately selecting the HER that will best fulfill them.

The EHR's impact on practice workflow is one of the most important factors to consider FOCUS ON WORKFLOW NOT SIMPLY FEATURES). It's essential to select an EHR that will automate workflow in the way the practice desires. To that end, a practice considering deploying an EHR can help itself by charting its processes prior to evaluating any systems. The practice can use that chart to identify inefficiencies or areas in need of improvement, and then outline a new, ideal practice workflow. Practices seeking information from EHR vendors should present their desired workflow to each company and ask if and how, specifically, the EHR can help the practice realize its ideal workflow. This can be a quick, efficient way to weed out vendors whose EHR products cannot meet the practice's needs.

The good news for small and solo practices is that the range of EHRs available has expanded so greatly that medical groups can reasonably expect to find an EHR that suits their needs at an affordable price. (ADVANTAGEOUS TO PRESENT A PLAN TO MAKE THIS HAPPEN UPFRONT TO THE PRACTICE...DEMONSTRATE YOUR UNDERSTANDING OF THEIR NEEDS AND YOUR FOCUS ON NOT JUST SELLING BUT HELPING THEM TO DO BETTER...SOLUTIONS SELLING!)

Real-World Success :

Although practices still have to do their homework in choosing and implementing an EHR, the conditions are increasingly favorable for small and solo practices. Real-world examples of medical groups that have implemented EHRs prove that small practices, like larger ones, can experience multiple benefits, from cost savings and reduction in paper-based processes to electronic prescribing and better access to patient information.

Stephen H. Mascio, DO, a solo family practice provider in Follansbee, W.V., had a range of goals in mind when he began considering EHRs, including providing better patient care by streamlining access to patient charts, increasing staff efficiency, and reducing the heavy volume of paperwork and charts.

Mascio based his choice of an EHR on functionality and affordability. He evaluated systems based on their capability for electronic prescription writing, on- and offsite access to patient records and data, centralization of patient records, and the ability to collect and track important patient data for improved medical care. Mascio also wanted a user-friendly system capable of communicating with systems outside of the practice, including reference laboratories and local hospitals. Vendor support is another important consideration, as Mascio's experience illustrates.

His practice deployed its EHR in 2007 and was fully live within a few weeks, thanks to the vendor's training and readily available support. The practice generates a strong return on investment, due in large part to a decrease in materials costs, including paper charts, prescription pads and printer paper and ink.(INFORM THEM OF OUR RESOURCES AND COMMITMENT TO TRAINING AND SUPPORT...THE LOCAL RESOURCE)

Advanced Medicine and Laser Institute, a solo practice in Streetsboro, Ohio, also stresses the importance of cost effectiveness in both the initial implementation and vendor support after installation. The practice installed its EHR in 2007 and immediately began using the system, addressing questions with the vendor as they arose. Advanced Medicine and Laser also took a deliberate approach to converting patient records. Rather than import all patient records at once, the practice decided to convert records the day before a patient's visit. That way, Advanced Medicine and Laser began getting the immediate value it wanted from the EHR (namely, ease of access to patient records) without tying up administrative resources. Once a critical mass of patient records had been converted, the practice began converting older records as time allowed.

Improved Administration and Patient Care

For small practices like Mascio's, cost savings from administrative efficiencies contribute significantly to an EHR's return on investment (ROI). Even for solo practices, considerable administrative staff resources are devoted to sorting, scanning and filing documents.

Because EHRs enable practices to go paperless, they can generate significant administrative savings. And when EHRs facilitate document transmission, lab tests and referrals for patient care outside the practice, the practice often receives far fewer calls from patients, providers and payers with questions about procedures. By reducing the number of paper-based charts, practices also save valuable office space traditionally devoted to filing cabinets for patient records.

Cost savings are essential, but healthcare providers are healers first and foremost, which is why another finding from the survey published in NEJM is so important: An increasing number of respondents reported a positive effect from EHRs on the delivery of long-term and preventive care. Given the impact on costs and patient care, it might be time to rethink the role of the EHR in small practices.