Challenges in EMR Usage

Recognizing that change is difficult, the federal government is offering incentives to health care providers switching from a paper to an electronic medical record (EMR). Surprisingly, these incentives are not offered through the recently passed Patient Protection and Affordable Care Act. Instead, in February of 2009, Congress passed the American Recovery & Reinvestment Act (ARRA), which included provisions for EMR Implementation incentives--the HITECH Act, passed before the Patient Protection and Affordable Care Act.

Why Switch to an EMR?

• An EMR allows quick access to a medical record and to storing all patient data in a comprehensive clinical information repository.

  The Medical Group Management Association recently calculated that "staffing is now at 4.31 full-time employees per physician ... and that this could be reduced to 2.2 full-time employees per physician after implementing an EMR system," resulting in an effective cost-cutting measure.

  Administrative and management benefits including a reduction in the costly tasks of creating and managing paper charts,chart retrievals and re-files; fewer misplaced or duplicate charts; improved communication and overall processes; and increased return on investment (ROI).

  With all these great improvements, why is introducing an EMR so challenging?

Challenges to EMR Implementation

• Health care providers seeking to use EMR systems in their practices face many challenges. Studies have shown that myriad factors impact the challenges of adapting an EMR, including lost patient care time for dedicated support staff, clinical staff and providers so they can become proficient with specific hardware and software.

  Other challenges include combining existing paper records with the new EMR, and the physical and virtual security of an EMR system.

  There are also the issues of codification and customization. Codification is necessary to make sure clinical input and retrieval are not arbitrary. Customization of the system is necessary to make sure the EMR design is useful.Will the system be tailor-made for work flows at the installation site?

  Hardware is another major challenge. Is existing hardware capable of running the system of choice? Can other hardware, such as diagnostics, be interfaced with the system?

  Of course, dollars are another big factor in implementing an EMR. Prohibitive start-up costs and ongoing maintenance costs need to have a rapid return on investment (ROI).

HIGHTECH Act

• The HIGHTECH Act is part of the American Recovery & Reinvestment Act (ARRA) that allows for incentives under Medicare or Medicaid, but not both. Providers can select which incentive makes better sense for them based on practice demographics.

  Under certain conditions, high-volume Medicaid providers can receive a 100 percent incentive to encourage adoption of EMR, including support services and maintenance.