Physician practices and EHRs: A square peg in a round hole

I am truly excited to be working with PhysBizTech and to have the opportunity to contribute alongside a very distinguished panel of expert bloggers. Having been directly involved with the research and subsequent development of an electronic health record (EHR) designed specifically for small physician practices, I am well aware of the lack of resources available to this segment of the healthcare market, and the additional pressure brought on by recent IT initiatives, particularly meaningful use. My goal for this blog is to attempt to fill in some of the knowledge gaps related to the recent push and confusion surrounding EHRs, and also to collaborate with and learn from the PhysBizTech community.

Before I dive into more specific topics surrounding EHRs and related technology and best practices, I’d like to provide a little background on myself and my experience with EHRs and physicians so that you get a better sense of my perspective on these issues. First off, I am a general tech enthusiast and would place myself firmly into Gladwell’s “early adopter” category. One example of such was my direct involvement in the research and development of an EHR designed specifically for small physician practices.

The EHR research project I mentioned was one that my company, VitalHealth Software, implemented in collaboration with Mayo Clinic’s Center for Innovation, a multidisciplinary department of design researchers, physicians,  project managers, administrators, business analysts, and financial and IT consultants dedicated to transforming the healthcare delivery process. The goal of this project was to truly understand what physicians in the small practice setting needed in terms of an EHR.

However, in order to establish a thorough understanding of the EHR’s role in the practices, we decided to have physician researchers shadow clinical staff over the course of six weeks and monitor all staff members’ (physicians, nurses, medical secretaries, administrators and front desk staff) interactions with an EHR – if they had one – or paper charts if they did not.  The physician researchers followed three small physician practices in Iowa, Wisconsin and Minnesota, all at varying stages of EHR adoption (one paper-based, one hybrid and one that was mid EHR adoption).

Over the course of the research, we were able to gain invaluable insight into the potential rewards and pitfalls, anxieties and excitement, hurdles and possibilities that EHRs represent for physician practices. We quickly came to realize that the bottom line is that smaller practices face a unique set of challenges when it comes to EHR adoption, and those challenges require a tailored solution. Trying to force an EHR designed for a hospital or health network into a small practice setting is like trying to put a square peg in a round hole, ultimately leaving the physicians and staff with a bad taste in their mouths — and with an expensive piece of technology that they cannot fully utilize.

While I recognize that there are issues that need to be addressed, I am an advocate for EHRs and do hold a strong belief that if it is done right the move toward electronic records will result in a more efficient and higher quality of clinical care.  Moving forward with this blog series I hope to share some of the lessons I have learned from this research project about the requirements a small practice EHR must meet and also discuss more general trends surrounding EHRs and related technologies.

Stay tuned for my next installment in which I will elaborate on the barriers small practices face when adopting and implementing an EHR.   

Arjen Westerink is director of business development at VitalHealth Software. He assisted in architecting the VitalHealth EHR designed with Mayo Clinic.

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