Tuesday, April 27, 2010

5 key barriers to adopting electronic medical records today

Electronic medical records, long-touted as a key to improving patient care and reducing medical errors, are getting a boost through federal stimulus money that, along with federal and state legislation, can reshape the health care industry.

Still, talk to people in health care and it is clear that there are myriad issues that need to be resolved before there is ubiquitous adoption of electronic records. Key challenges include financing the conversion from paper to computerized records, designing the work flow, making systems easier to use, integrating files from multiple sources and, of course, ongoing technical support.

It’s estimated that about 50 percent of all Massachusetts physicians are now using electronic medical records, while the national adoption rate is far lower. Typically, there is a higher degree of penetration of digital records at large hospitals and smaller hospitals that are part of health systems that have subsidized the conversion from paper records. In small group practices or independent doctor’s offices, where the majority of health care is actually delivered, electronic records have been adopted more slowly. In Massachusetts, for example, about 25 percent of doctor’s offices (where there are usually just a handful of practitioners) are using electronic records, according to Micky Tripathi, CEO of the Massachusetts eHealth Collaborative, a nonprofit that has been working with physicians to implement computerized health records.

So, what are local companies doing to address some of the key barriers to adoption and standardization?

Money
Converting reams of paper files to digital records is expensive. While the federal stimulus bill promises between $44,000 and $65,000 to doctors who convert to electronic records, the funds will be paid in increments over a span of a few years. Finding the upfront funding to implement an electronic medical records system can be tough, particularly for smaller health care providers. The emerging Regional Extension Center, being organized by the Massachusetts eHealth Institute, is expected to make available low-interest loans to eligible providers for EMR conversion to as well as support and education services for doctors migrating to digital records. The extension center is expected to be up and running next month, according to Rick Shoup, director of the eHealth Institute, a division of the Massachusetts Technology Collaborative, a quasi-public economic development agency.

Several companies have tried to reduce the cost of getting started with electronic records. EClinicalWorks, an EMR and medical practice management company in Westborough, has developed software-as-a-service offerings, where it hosts clients’ electronic records for a fee. This arrangement reduces the upfront costs of getting records computerized and provides the expertise needed to make the transition. The fast-growing, privately held company has also partnered with Wal-Mart Stores Inc. and Dell Inc. to offer bundled EMR software and hardware through Sam’s Clubs to smaller practices and doctors’ groups.

AmazingCharts.com Inc. is another New England company that has targeted small health care practices. The North Kingstown, R.I. startup has developed EMR software for physician groups or doctor’s offices with five or fewer practitioners. More than 3,400 physician practices have licensed the company’s software, which has an entry-level price of $995. Founded by Jonathan Bertman, a family physician, the company also offers add-on services such as technical support and off-site data backup.

Work flow
Converting to electronic records not only means a shift from paper files, it often requires an overhaul of the processes for treating patients, said Janie Tremlett, vice president and chief marketing officer of Concordant Inc., an IT health care services company based in North Chelmsford. Concordant helps clients develop the work flow for electronic records by taking doctors by the hand and talking through how they interact with patients. The company also tries to identify any potential snags in adoption, such as staff members who might be computer-phobic.

“We sit down with a practice and put the big, stinking fish on the table,” Tremlett said.

The company has developed an online library with information about best practices for workflows for electronic health records as well as other resources that document policies and processes for different medical specialties. The company has been using the library internally and is getting ready to launch a pilot in which the content will be part of a self-service portal that customers can access with a web browser.

Ease of use
For an EMR system to be successful, it has to be simple to use and must not slow down the flow of patients, said John Moore, managing partner of Chilmark Research, a health care industry market research firm in Cambridge. Typically, when electronic medical records are introduced, physician productivity can drop by as much as 30 percent as doctors learn the new system, he said. In a compensation system that is based on the number of patients treated, anything that hampers throughput will be met with resistance. “A key issue is making systems easier for doctors to adopt,” he said.

Sentillion Inc. has tried to simplify the process of accessing medical records. The Andover company, which was acquired by Microsoft Corp. earlier this year, offers doctors a single-sign-on application, allowing them to access medical records from different departments such as laboratory, pharmacy or radiology by logging in once, rather than having to log into multiple systems. Microsoft is integrating Sentillion’s software, which also includes a context-management application, into its Amalga Unified Intelligence System, software for accessing health care data from multiple sources. While the Microsoft deal closed in February for an undisclosed amount, Sentillion has remained at its Andover address and is continuing to sell and support its product line.

Performance Measurement
Under the new federal health care reform legislation, there will be new requirements for reporting information about the quality of care and compliance with regulations.

“Performance improvements is one area that is really emerging” in the health care IT market, according to Joseph Restuccia, a professor of health care and operations management at Boston University. Several local companies are targeting this market with products that aim to help providers analyze and measure their performance. MedVentive Inc. of Waltham has developed software that helps health care providers pull information from different sources to analyze and track performance and outcomes. Founded in 1997 by CareGroup Health Systems, the parent organization of Beth Israel Deaconess Medical Center, MedVentive was spun out as an independent entity in 2005.

Under a software-as-a-service model, Humedica Inc., a startup headquartered in Boston, is offering tools that can be used to analyze and benchmark patient care. Investors have expressed confidence in the company — Humedica officially launched last fall with $30 million in venture funding.

Support
Once health records are digitized, they will need ongoing support and maintenance. This will be especially challenging for the small and midsize medical practices and doctor’s offices that don’t have the expertise or the resources to handle the work.

“Most health care providers are small. If the price of admission (for implementing EMR) is hiring an IT person, it won’t work,” says Ray Campbell, executive director of the Massachusetts Health Data Consortium.

Having the health records hosted by a software-based service provider will ease the support burden and “bypass some of the technology issues” such as security, compliance and privacy concerns, because the service providers should be able to offer more secure and reliable systems than what the health practices could build and maintain on their own, Campbell said.

“Software as a service has such great appeal to small practices because they do not have internal tech support,” said Thomas Sullivan, a North Shore cardiologist who is chief strategic officer with DrFirst, a Rockville, Md., company that sells electronic prescription-management systems.

Watertown-based AthenaHealth is one of the companies offering EMR under a software-as-a-service model. The company hosts the data and maintains the system, while physicians access their files through a web browser. The company, which started out providing billing services in 1997, introduced its electronic health record service three years ago and has grown steadily, said John Hallock, a company spokesman. Last year, revenue was up 38 percent to $188.5 million.