CHAPTER 23
Choosing the Electronic Health Record
John Shufeldt
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ONLY A SMALL NUMBER of physicians in the United States fully use an electronic health record (EHR), even though EHRs have been widely available for years. Common barriers to adoption have included excessive setup and maintenance costs, disruption to physician productivity, legal concerns, and insufficient demonstrable financial or clinical benefits. However, thanks to technological progress, as well as incentives offered by the Health Information Technology for Economic and Clinical Health (HITECH) Act, consumer demand is finally overcoming resistance and spurring adoption.
The General Accounting Office estimated that over $200 billion could be saved annually in the United States with more widespread adoption of EHR systems by physicians. In addition, the General Accounting Office estimates that nearly 100,000 lives could be saved annually. Couple those predictions with EHR vendors’ promised positive return on investment (ROI) and productivity improvements, and what’s not to love? Apparently, given some of the challenges in EHR adoption, quite a bit.
For example; a 2013 study from the University of Michigan School of Public Health found that practices that implement an EHR without a well-thought-out plan and dedicated focus on enhancing revenue and cutting costs are likely to lose more than $43,000 over 5 years. In other words, 73% of those surveyed failed to see an ROI.1 Notably, a 2012 user satisfaction survey of the American Academy of Family Physicians showed that only 38% of respondents were highly satisfied with their EHR systems.2
This chapter offers a road map to successful EHR selection, adoption, and implementation. It reviews today’s EHR competitive landscape, including both opportunities promulgated by the HITECH Act and the hazards of adopting the wrong solution. It then suggests ways to plan for and select an EHR partner that provides your practice with clinical insight and operational efficiency while ensuring accurate documentation and compliant coding.
The process of vetting and implementing an EHR system is challenging for any medical group. But the right EHR solution can help your practice generate more revenue, improve efficiencies, and provide access to better metrics, allowing you to focus on patient care.
Before going further, it is important to note the difference between electronic medical records (EMRs) and EHRs, because multiple terms with overlapping definitions have been used to define electronic patient care records. Both terms, EHR and EMR, have gained widespread use, with some health informatics users assigning the term EHR to a global concept (think: personal health records) and EMR to a discrete localized record.
Others prefer to define an EMR as the physician interface, and once you add a patient portal to your EMR, you get an EHR. This builds on the idea that once the patient is submitting information, it’s no longer a medical record but at that point becomes a health record. For most users, however, the terms EHR and EMR are used interchangeably. For the purposes of this chapter, EHR denotes the patient’s medical record and the system employed to capture the information and formulate a billable encounter.
In 2004 President George W. Bush called health information technology a national priority. Despite this announcement, few steps were taken toward nationwide EHR implementation until 2009, when the American Recovery and Reinvestment Act earmarked as much as $36 billion for the expansion of health information technology in the United States. This was one of the most notable steps toward widespread EHR implementation, and it ultimately led to the HITECH Act. The HITECH Act was signed more than a year before President Barack Obama signed the Patient Protection and Affordable Care Act into law and is not part of the Affordable Care Act.