"I was getting buried in paperwork," he recalls. "I needed to get letters out to referring doctors and it wasn't getting done. I was losing patients. There would be a stack of charts for me to review and another stack of charts for the office manager to check before I got them." Now, referral letters are templated in his SpringCharts EHR from Houston-based Spring Medical Systems Inc. and finished before patients leave the office.
The force that most compelled Princeton (N.J.) Orthopaedic Associates to migrate to electronic records was the financial cost of not doing so. "We were using an awful lot of people to keep track of charts," says Rob Simpson, director of the four-site practice comprising 17 physicians and 120 staff members. "We knew what our costs were for the file room. Like any other information technology decision, it was a pretty easy decision and we have close to a one-year return on investment." The practice uses the document imaging and EHR applications of SRSsoft, Montvale, N.J.
Neither practice, however, felt pressure to go electronic from other market forces perceived to be influential. Patients weren't pushing them to automate, nor were insurers or government agencies. And both Ashby and Simpson are unaware of any hospitals in their service areas rolling out I.T. donation or subsidy programs.
"Nobody was pushing us in that direction," Simpson says. "Nobody seems particularly interested. I thought attorneys would like it, but half of them can't handle electronic media and want the chart printed and mailed to them."
In Simpson's opinion, physicians themselves are the main driving force. Practices are becoming more sophisticated at I.T. planning and recognizing the importance of building I.T. and support infrastructures, he notes. During the last three years, Princeton Orthopaedic has hired an I.T. director and support staff, and Simpson regularly hears the same story when he talks with peers.
Further, physicians are becoming accustomed to using computers at the hospital and at home, he adds.
But in some parts of the nation, the aforementioned market forces are making an impact. There are signs that the federal government's revamping of rules to permit hospitals to donate I.T. systems and services to community physicians are starting to bear fruit, says Patrick Cline, president of NextGen Healthcare Information Systems Inc., a Horsham, Pa.-based physician software vendor.
"We have noticed an up-tick in the interest level of hospitals, and we do see them having related strategies in place or developing their strategies," he notes.
The Methodist Hospital System in Houston is developing a donation program. The Department of Health and Human Services' ruling in August 2006 to permit such programs provided an impetus for the project, says Matt Fink, vice president of information technology. "We had a strategy; the rules certainly made it easier."
Donation programs are most likely to evolve in competitive regions with four or five delivery systems, Cline says. "If one hospital can turn a large cardiac practice away from another hospital, it's worth millions of dollars to do it."
But he also sees some activity in non-competitive areas, in what he calls "Bozeman, Montana-types of places with a dominant hospital." For example, seven-hospital Munson Healthcare in Traverse City, Mich., has little competition in the hospital market, yet is rolling out an I.T. donation program (see story, page 32).
Other market forces, such as more affordable contract terms, and industry efforts to develop data standards and EHR certification programs, are starting to factor into decisions on whether to pull the trigger and adopt clinical systems.
Certification from the Certification Commission for Healthcare Information Technology was an important consideration when Advanced Pediatrics Associates in Aurora, Colo. chose its EHR vendor. "It's like a report card," says Mark Pearlman, M.D., a pediatrician and the practice's computer guru. "Do you really want someone with consistent D's, or A's and B's?'"
Even some physicians who adopted an EHR before CCHIT's program believe certification has value for other provider organizations now considering an EHR. "Having a certification program will give physicians confidence that someone has looked at the product and it's at least reasonable," says David Fairbrook, M.D., owner of The Clinic at Panorama City in Lacey, Wash.
The biggest change in the market may be a readiness among the physician community to implement clinical systems that wasn't present three years ago, says Chris Podges, corporate vice president of information systems and CIO at Munson Healthcare.
"People started to take notice as a handful of influential clinics took the jump," he notes. "There is a growing sense of inevitability, and the products have matured and gotten less expensive."
For Advanced Medicine & Laser Institute in Hudson, Ohio, the jump to an EHR occurred when solo practitioner Mahmud Kara, M.D., opened a second office in nearby Ravenna. "Sometimes, patients will see him in both offices and it's really hard to move charts back and forth," says Angela Ziccardi, office manager.
So Kara, an internist specializing in cosmetic and natural hormone replacement procedures, and his staff planned last month to go live with a combined practice management/electronic records system from Henry Schein Medical Systems, Melville, N.Y.
The practice considered an EHR several years ago when it just had the single office, but the cost was prohibitive, Ziccardi recalls. Now, prices and usability are better. She also expects good support because the software was bought from a local reseller.
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