Smooth Adoption of Electronic Health Records Requires More than Hardware and Software

by Tom Walsh

Patrick Barbier, M.D., runs a solo family practice in Newburyport that will be one of the first to “go live” with electronic health records (EHRs) this month as part of a much-anticipated pilot program. He and his two staffers are both enthused and apprehensive at the prospect of going paperless.

Massachusetts eHealth Collaborative President Micky Tripathi (inset), leads the nonprofit organization that coordinates EHR implementations like this one at Newburyport Family Practice.

“Everyone’s excited -- and a little frightened,” said Dr. Barbier. “I think it will help in the future, but I think it will be hard to get used to. There will be a learning curve. At the beginning, it will slow us down.”

Like most practices today, Dr. Barbier’s already has a computer for billing. He’s also done some e-prescribing. “But with this,” he said, “we’ll be hooked up to the hospital. We’ll be able to download lab work, x-rays. Everything will be right in the computer and it will make things much easier. I’ve been waiting for this for many years.”

First Pilots Ready to Launch
That vision of health care connectivity is supported by a $50 million grant from Blue Cross Blue Shield of Massachusetts. The grant has fueled the pilot program now moving forward in physician practices and hospitals in Brockton and North Adams, as well as Newburyport. The hope is that these early programs will demonstrate the benefits of linking doctors and hospitals technologically so they can share information smoothly, reduce medical errors, better control costs, and create a more efficient health care system statewide.

“For doctors, this means that their whole office will be based on an electronic workflow, not a paper record,” said Micky Tripathi, president of the Massachusetts eHealth Collaborative (MAeHC), the nonprofit organization formed to coordinate the pilot programs. “Doctors will document all of their encounters in an electronic record -- phone consults, e-prescribing, prescription refills, patient notes, complaints, histories. We hope we will get efficiency. For certain, it will change the way the physician’s office works.”

The Barbier practice is one of eight practices in Newburyport that began choosing technology vendors back in December. The program covers the cost of technology and provides hands-on support from an 11-person MAeHC practice service team, whom Tripathi describes as “facilitators and navigators” for the practices. “We’re hoping that with a little bit of hand-holding, we can get the practices into this more easily,” he explained.

Dr. Barbier is grateful for the help. “Doing it on my own would be more difficult,” he said, adding that he also welcomes the program’s financial assistance. “Although the technology is getting better and better, it is not getting cheaper,” he said.

More Complex Than It Seems
Getting doctors on their way in the pilot program is not as simple as it may seem. Says Tripathi, “Each office has its own way of doing things. What we provide is relatively standard, but the implementation process is different based on what the practice has. The task is to take all the automation they are using now, such as electronic practice management systems, and reorient them to the electronic health record.”

The sheer scope of the project also adds complexity. In all, the eHealth Collaborative pilot program covers 160 practices in the three regions. That’s 450 physicians -- 300 in the Brockton area, 90 in Newburyport, and 60 in North Adams -- as well as 150 nurse practitioners and physician assistants.

Partners Aggressively Promoting EHRs
Meanwhile, Partners Community Healthcare, Inc. (PCHI) -- a physician network of more than 4,500 primary care physicians and specialists that cares for more than 1.5 million patients in eastern Massachusetts -- is moving aggressively to bring participating physicians into its own EHR program.

“We think of electronic medical records as being really critical,” said Jeffrey K. Levin-Scherz, M.D., PCHI’s chief medical officer. “It’s the way to coordinate care better and to offer better quality of care.”

Dr. Levin-Scherz said that at Partners’ academic medical centers, Massachusetts General and Brigham and Women’s Hospitals in Boston, 89 percent of primary care physicians and 82 percent of specialists were using EHRs as of the end of last year. EHR use is significantly lower (43 percent) in Partners’ community medical groups, and at its physician-hospital organizations, EHR rates are 34 percent for primary care doctors. Overall, 53 percent of the network’s primary care doctors have gone electronic, as have 52 percent of the network’s 3,500 specialists.

With EHRs, everyone’s long-term goal is “interoperability” -- that is, the ability of all the state’s care providers, hospitals, and patients to appropriately share information. Dr. Levin-Scherz is confident that interoperability will happen despite multiple initiatives using various vendors across the state. However, he said patient privacy issues and system nuances may thwart 100-percent interoperability.

MMS to Help Small Practices
B. Dale Magee, M.D., a Shrewsbury gynecologist and MMS vice president, has chaired the Society’s Information Technology Clinical Advisory Committee, which has been an important driver of EHR progress. Dr. Magee thinks the embrace of technology may be the most important health care development in a generation. “It’s going to change things in ways we haven’t even thought of yet,” he said. A hundred years ago, he added, doctors thought the advent of the automobile would change medicine because it would expedite physician house calls. “But the real benefit occurred when patients got cars and could drive themselves to their doctors’ offices,” he said.

In late January, the MMS Board of Trustees approved recommendations from Dr. Magee’s committee that are designed to help smaller physician practices across Massachusetts adopt EHR systems. “One of our great concerns is that physicians in small groups will be left out and not able to compete without interoperable systems,” said MMS President Alan M. Harvey, M.D., M.B.A. “What we are trying to do is level the playing field and make sure that when it comes to EHRs, we have a way to include all physicians for the greater good.”

Dr. Magee said the most important of his committee’s recommendations is the plan to provide smaller practices with a suite of services that will include office analysis, consultation, and continuing EHR education. “We intend to piggyback on the eHealth Collaborative experience,” Dr. Magee said. “They are making recommendations, and we are trying to track with them. We’re also cosponsoring education programs with them.”

The Society trustees also agreed with a consultant’s recommendation that the MMS work with four EHR vendors. At the same time, the MMS will focus on a single vendor -- eClinical Works -- for added education and support. The MMS will also offer enhanced member service in this area -- beyond that described by Dr. Magee -- for an appropriate fee.

Dr. Magee said that busy physicians need as much help as they can get to upgrade their practices to EHRs. MAeHC’s Tripathi is optimistic that his organization’s pilot programs will eventually help get most of the state’s doctors to use electronic health records. His group has already assembled a capital funding committee to look at ways to pay for widespread implementation, which Tripathi said could cost $750 million to $1 billion. “But installing hardware and software is not enough,” Tripathi added, echoing Dr. Magee. “Physician offices need our consulting and educational support.”