Electronic Medical Records Drive Physicians to Stay, Go

After 25 years of using paper records, Winfield Young, MD, recently dove into electronic medical records for his Virginia Beach, VA, pediatric practice. "Today is the first day of training. I'm tickled pink," Young told me.

Young wants to maintain his freestanding practice and not be employed by a hospital. With an EMR, he envisions the possibility of increasing his income, and definitely more efficiency. "We see the importance of better documentation of diagnosis, and it's going to be easier to track," he says.

Independent primary care physicians often think they don't have the time, money, or resources to implement EMR, even with government subsidies. Still, they know they need to adapt to the changing environment. Patients are demanding more transparency and the government is incentivizing the shift. A growing number of physicians seem to figure they have no choice. To survive, they must opt for EMR, though they know the journey may not be easy.

Joel L. Fine, MD, of Fine & Associates in Snellville, GA, who runs a solo practice with his wife Stefanie overseeing the records, was certain for many years that he wasn't going to bother with EMR. "I fought the idea of electronic health records," Fine told me. "My feeling was: I don't need one. It doesn't help my practice; I don't see any benefit to it." Just the idea of dealing with vendors was daunting, Fine says, "with all of them geared to taking advantage of you."

But his thinking changed gradually. He remembers attending a vendor meetingwhere a show of hands was asked for physicians who weren't getting EMRs. "My hand was the only one up," Fine recalls. "Here I am, I thought, at 45 years old, at my peak of my career, and would be recognized among my peers as an outlier."

Fine converted. He is far from alone. More than 69% of primary care physicians reported using EMRs in 2012, up from fewer than 46% in 2009, according to a newly released Commonwealth Fund report published in Health Affairs.

Despite the spread of EMRs, U.S. primary care physicians trail doctors in other countries. The report says that U.S. and Canadian doctors lag behind the United Kingdom, New Zealand, and Australia in use of EMRs and healthcare IT to perform a range of functions, like generating patient information and ordering diagnostic tests.

Even so, U.S. doctors are exceeding goals set by the federal government. In August, the Department of Health and Human Services announced that 120,000 eligible health care professionals and more than 3,300 hospitals had qualified to receive incentive payments under the "meaningful use" rules for EHR adoption that went into effect in January 2011. That exceeds HHS's goal of 100,000 set earlier in 2011.

There's a twist, however: while U.S. doctors are moving forward in using electronic medical records, the mere presence of this technology is among the reasons they are moving out of their existing private practices and toward hospital employment, according to a report from Accenture.

Accenture says that over the next 18 months, more doctors are expected to leave private practice for hospital employment, due to "rising costs and technology mandates."More than half the doctors (53%) cited EMR requirements as a main reason for leaving private practice. The Accenture findings resulted from extensive market analysis on U.S. physician employment and a survey of 204 physicians in independent practice conducted in March 2012.

"On the technology side, many physicians we surveyed were daunted by the cost and complexity of certain technology mandates such as [EMRs]," says Kaveh Safavi, MD, JD, Accenture's health industry leader for North America. "Everything from the selection of an electronic medical record to the maintenance of the technology infrastructure and the compliance, it's all very complex and something that has been frustrating for many small practices."

Even IT companies that are working with physicians like Fine and Young in developing EMRs acknowledge the reluctance of physicians to embrace it. Fine and Young both use Hello Health, a New York–based web-based patient management platform for medical records and messaging. According to Hello Health's Primary Care Physician Attitudes survey conducted this summer, 37% of physicians see EMRs as their number-one challenge—the same percentage that see practice financial issues as their foremost concern.

Fine says it was important to have extensive technical support with the Hello Health platform while starting up an EHR. "We have a patient portal and the training was for free," Fine says.

The Hello Health survey showed that, among physicians who said that practice financials were among their biggest challenges, 51% felt implementing an EHR would help their practices, especially in dealing with coding and documentation.

Coding may have been the last straw for Young as he switched to an EMR.

"I've got 25 years of experience in using paper charts," Young says. "What, we're talking about more than 25,000 codes for ICD-9 [diagnostic codes] and then a lot more for ICD-10? Already, practice work is time-consuming with paper. I'm looking for the promise of what's ahead."