Lessons in EHR: What we have learned

Listen to Michael V. Boland, MD, PhD, share more about the implementation of an electronic health record system at the Wilmer Eye Institute. 

Take-home

The implementation of an electronic health record system at the Wilmer Eye Institute has shed light on its use, adoption, satisfaction, and productivity.

By Liz Meszaros; Reviewed by Michael V. Boland, MD, PhD

Baltimore-The implementation of electronic health records (EHRs) has increased over the past few years, but physicians’ satisfaction and productivity have dropped slightly, said Michael V. Boland, MD, PhD.

Dr. Boland, director of information technology and assistant professor of ophthalmology at the Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, offered some statistics on EHR use, adoption, satisfaction, and productivity, as well as some tips on how to implement successfully an EHR based on his experience with the system at the institute.

Survey of membership

In 2007, the American Academy of Ophthalmology conducted a survey that found only about 12% of ophthalmology practice were using EHRs. That was consistent with other specialties, noted Dr. Boland.

In addition, roughly, two-thirds of people were satisfied with their products; two-thirds saw increased or stable productivity; about one-half had stable or increased costs.

Finally, results showed that about three-fourths of users would recommend an EHR to someone else.

In late 2010, this survey was conducted again with 392 ophthalmologic practices. Questions addressed practice demographics, adoption of electronic systems, readiness for “meaningful use”, and satisfaction with their systems. After culling and analyzing the responses, said Dr. Boland, data showed that practices with EHRs tended to be larger, more likely to be multi-specialty groups, and less likely to be physician owned.

“The bottom line is that the people who are still without EHR tend to be the smaller, doctor-owned ophthalmology-only practices,” Dr. Boland said.

In this latest survey, continued Dr. Boland, 32% were actively using EHRs, another 13% were in the process of deploying EHRs, so roughly one-half of practices were on or about to be on EHRs at that time. Including those practices planning to implement an EHR, roughly 75% of ophthalmologists would be up and using an EHR by 2014. This means that roughly one-fourth of respondents had no plans to go to an EHR.

Satisfaction measures

Satisfaction rates have changed somewhat from the first survey to the second, continued Dr. Boland. Productivity in the first survey was increased or unchanged in roughly two-thirds of responding practices; this has changed to 40% of respondents with increased or unchanged productivity. Costs were decreased or unchanged in roughly 50% of respondents in the first survey, and this decreased to about 20% of respondents in the second survey.

Finally, those who would recommend their EHR to others was at 76% in the first survey, and this decreased to 55%.

“People are less likely to recommend their products to their colleagues; they are feeling less productive; and generally less satisfied compared to 2007,” he said.

More questions

In the most recent survey, said Dr. Boland, respondents were queried regarding their perceived (if they had no EHR) or realized (if they did have one) benefits of and barriers to EHR adoption.

“The costs both in terms of time and money were the biggest barriers. This was true whether respondents had an EHR already or not,” Dr. Boland said.

The most common perceived benefits of EHRs included improved handling of medication refills, access to medical records from anywhere, and help selecting billing codes.

Meaningful use

The government has required practices to demonstrate the actual utility and benefit of EHRs in order to prove that they are engaged in meaningful use of an EHR, said Dr. Boland. Roughly 30% of respondents said they were ready to run meaningful use tests with their EHRs, 25% needed to either install their system or upgrade it to be ready for these tests, and another 20% had no plans for this, and 18% had no plans to do anything for meaningful use.

“The overall big picture is that EHR adoption has increased from 12%, to well over 50% by this point. Practices were generally less satisfied in a number of measures now than they were back in 2007. Finally, more than 50% of ophthalmologists were pursuing meaningful use. According to the latest data, at least 6,000 ophthalmologists have attested for meaningful use and gotten payment from Medicare for using an EHR,” he concluded.

Michael V. Boland, MD, PhD

P: 410/583-2802

E: boland@jhu.edu

Dr. Boland receives lecture fees from Carl Zeiss Meditec.

4 tips for successful EHR implementation

Dr. Boland shared the results that they have had in implementing and EHR at the Wilmer Eye Institute, and summed it up with what they have learned from their experience:

·      Preparation is key. “You can’t spend enough time preparing, because this is a big deal and will change your whole practice,” he said.

·      This EHR will control your whole clinical life. “Either you let it control you or you seize control of the product and make it do what you want it to do,” he said.

·      Balance standardization and personalization with your product.

·      Success is proportional to engagement. “Those doctors and groups that were most engaged in the process were the most successful,” Dr. Boland concluded.