EHR Implementation Proves More Challenging for Physician Stakeholders

Physicians at smaller, independent practices might have more of a say when it comes to picking an EHR. But they also have many more challenges when it comes to implementation, according to a new study.

Researchers at Boston University Medical School and Boston Medical Center - who surveyed 156 Massachusetts physicians who participated in a pilot program run by the Massachusetts eHealth Collaborative -found that 38 percent of physician owners considered EHR implementation “very” difficult, compared with 26 percent of non-owners.

The study, which was first published by the Journal of the Medical Informatics Association, also revealed that 54 percent of physicians found EHR implementation “somewhat” difficult, while only 12 percent said it was a piece of cake.

Physicians and practice managers expressed mixed reactions to the study.

Texas pediatrician and practice owner Rodrigo Argenal told Physicians Practice he is “a bit surprised” by the findings in this study, and that he wonders if the difficulty was not due in part to the particular EHR system being utilized.

That being said, he agrees that the financial aspects of owning an EHR can be stressful.
“It is not easy to change EHRs once instituted, which may cause extra stress, adding to the perception of difficulty in adopting an EHR,” says Argenal. “Over the last few years, outpatient EHRs have become much more user friendly and efficient in their workflow. I use Cerner and have found it to be quite easy to implement despite some initial difficulties that come along with any change, not because of the system itself but mainly because of getting used to an electronic only system. Financial burden is always a consideration which, as owner of my practice, always played a role.”

Argenal says EHR owners should try to do as much homework in advance, studying EHR options closely before choosing a system.

However, the study might not necessarily reflect the most current trends, said physician Richard Corson, who noted that the study, which was done between 2005 and 2009, is somewhat dated in view of the speed that IT is developing.

“Servers were quite more expensive then and cloud-based systems few and far between,” Corson told Physicians Practice. “Vendor choices were limited and few of them wanted to deal with smaller practices.”

That being said, “as a practice owner I can tell you that implementing an EHR is difficult and initially expensive,” he added.

“There is a lot of planning and grunt work needed that employed physicians don’t have to sweat over,” said Corson. “Larger organizations with full-time IT and management staff can implement a system and teach the docs how to use it. In smaller practices it is the physician owner who has to make all the decisions needed for implementation, work nights and weekends to make it happen, budget the funds to pay for it, and be a champion to the other docs and office staff so they will embrace the EHR.”

Family physician Christopher Tashjian, who works at a multi-location 20-physician independent practice in River Falls, Wisc., echoed Corson’s sentiments.

“When you’re an owner, you’re basically responsible for all the cost,” Tashjian told Physicians Practice. “So my friends employed by the big health systems don’t get any say in it but they don’t worry about it.”

For Tashjian, the first year of having an EHR was particularly stressful, as productivity delays had a direct financial impact. Still, he feels the advantages of being an EHR owner are significant.
“We chose the EHR we purchased,” he says. “We went in and evaluated, ‘which was the right one for us?’”

Practice administrator (and Practice Notes contributor) Derrick Berger, says he’s also not surprised by survey results.

“Physicians have that problem with wanting to be involved in every step of everything, not just an EHR,” Berger told Physicians Practice. “They have to let go and practice medicine by investing the time to find someone who is qualified. I think that problem is felt more when they're owners of their practice and I bet the smaller the practice, the more it's felt.”

IT consultant Beverley Caddigan says the best way to relieve financial and other EHR-related stress is to embrace it.

“Rather than look at it as a challenge, consider it an opportunity,” Caddigan told Physicians Practice. “If there was an opportunity to learn a new moneymaking procedure, they would likely go for it. An EHR, if embraced fully, with a competent provider and the right IT infrastructure, can do more to have a positive impact on their practice than they can imagine … a few months of learning and upheaval is worth the many benefits they will realize in return.”