If the move toward electronic medical records were a race, the Valley Baptist Health System was ready to lap competitors several years ago. The system began looking into electronic medical records in 2008. James E. Eastham, president and CEO of the 800-bed hospital system in Harlingen, TX, was pretty excited about it then, remembering how everyone in the system was getting involved, and he saw physicians as part of the solution.
Within a short period of time, however, plans came to a sudden and costly halt. Physician "resistance" was part of the problem, Eastham recalls.
"We were excited about going to the EMR and spent a lot of time and resources and a lot of money. We wanted to be early adopters," Eastham says, recalling what turned out to be a humbling EMR transition, which is always a good lesson to everyone, physicians included.
"We got off to a rocky start. It wasn't easy, although we had the best of intentions," Eastham adds.
At Eastham's hospital system, the initial projected cost to implement its IT system was $18 million. "We knew we had to make it as user-friendly as possible," he recalls. The hospital's internal IT team set up the system and was assigned to bring physicians on board. The system was all set up. Then, little by little, flaws were exposed. The system wasn't as "user-friendly" as initially thought. Physicians had trouble logging on. There was mechanical resistance, and physician resistance.
"It was a big transition and [there were] big expectations," he says. "There was just so much resistance from the medical staff. It wasn't working for them. Using the internal IT staff wasn't working," Eastham says. "We probably had to too many consultants coming in; we didn't have the depth internally. We hired a lot of different consultants and that sent the costs up.
The physician relationship with electronic medical records continues to evolve. The hospital system was so concerned with ensuring that physicians were hooked up to the system, that the hospital neglected one of its most crucial elements, the computer system. "We should have refurbished all the computers on the floor. It wasn't as operational as it should have been," Eastham says.
Eastham's early experience is reflected by physician concerns elsewhere. The Medical Group Management Association released findings this month that illustrate some of the obstacles for physicians in moving forward with EMRs or EHR (electronic health records). The MGMA survey includes data related to physicians' own productivity as well as participation in the government's meaningful use incentives and overall costs.
While most (80.1%) medical practices surveyed who already adopted electronic medical records said they intend to participate in the meaningful use incentives available through the HITECH Act, only 13.6% indicated they are able to meet the 15 core criteria for eligibility to receive incentive payments. Interest in qualifying for EHR incentives was also strong among the respondents who now use paper medical records, with 28.8 % indicating they were in the process of selecting an EHR system, according to MGMA.
Most electronic medical record owners – 72% - said they are satisfied with their overall systems. They were split over their ability to increase physician productivity: 26% reported that productivity had increased; 20.6% indicated it had decreased, with 42.9% reporting there was no change in productivity after launching an EHR system.
About 38.4% of electronic medical record users said total practice operating costs increased, while 25.9% say the costs decreased; 25.7% reported no change.
The government's "EHR incentive program seeks to address implementation costs, a critical barrier to medical groups' adoption of EHRs," MGMA President and CEO William F. Jessee, MD said in a statement, but it is "clear that groups face significant optimization challenges."
"We are hopeful that as the future stages of the incentive program are developed, the government will take into account the difficulties medical groups currently face in meeting the meaningful use requirements," Jessee said.
Many physician leaders are hopeful for the federal incentive funds. funds the HealthLeaders Media Industry Survey 2011 shows that 44% of physician leaders plan to take advantage of federal funds to "install or upgrade" an EHR; with another 13% saying they won't be eligible to receive funds until after 2011. About 24% say it was "too early to tell" and 3% say physicians weren't on board.
Health leaders certainly know about frustrations in starting up EMRs. Steve Johnson, CEO of Susquehanna Health in Williamsport, PA, told the American Hospital Association representatives at their membership meeting in Washington DC this week about some of the problems he faced in beginning an EMR system.
His hospital system relied on a chief medical information officer to handle all the issues, says Johnson. The rest of the staff, however, depended too much on her, too, Johnson says. The consistent refrain of medical and clinical staff: "I'm not going to deal with IT, Dr. Jane will do it," he adds. They figured: "She'll take care of it. She'll do it. That was the mantra from the medical staff to a lot of the clinical staff," he recalls.
The chief medical information officer left her post, and the rest of the hospital system leadership were left in the dark as far as EMRs were concerned, Johnson says. Hospital leadership, however, working with physicians, found ways to improve their situation and aren't looking back. After the leadership left, Johnson says a chief medical officer began running the system, and a physician champion was identified to help and "all of a sudden there was engagement. It is something we wish we [had] started [with] right off the bat."
Generally, according to MGMA, physician practice ownership has influenced EHR implementation and optimization. "Interestingly, independent medical practices were more likely to have a fully implemented and optimized EMR than their peers owned by hospital systems," the MGMA report states.
The Inland Northwest Health system found a way to engage physicians while implementing a common hospital information system across 34 mostly independent hospitals in Washington state and Idaho. The result has been a regional data repository system with standardized data selection, under a Meditech Information Technology system of San Antonio, TX, with improved efficiency and lowered costs, according to Thomas Fitz, CEO of Northwest Health Services in Spokane, WA.
As the health system began implementing the regional data collection service, the concerns of physicians were paramount, says Fitz. When the program was launched, 100 doctors wanted to meet him. He was reluctant. To Fitz's surprise, the physicians told how they wanted to become integrated into a data collection system, relating their own "horror stories" of hundreds of thousands of dollars lost in investments, "systems down 18% of the time" and staffs simply tiring of trying to manage their EMR systems.
As for Eastham, he refused to give up on EMR, and retrenched, hiring an outside consultant, Anthelio Healthcare Solutions, of Dallas, TX, which specifically worked directly with staff, educating them about the new system, and, most importantly, spending time with them. If physicians had a "problem," the specialists visited them, Eastham says.
"There was a SWAT team, and (computer) fixes were made on the spot. It was costly but you can't have our medical staff not accessing the system," Eastham says. "We developed a schedule for training; they were very time-consuming sessions." At general staff meetings, the consultants would "walk (the physicians) through the system. Once they got used to it, all the bugs were worked out,"Eastham says, "And as those got more familiar with it, they loved it."
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
