Investment in electronic medical records systems is soaring, according to the results of the 2003 Modern Physician/ PricewaterhouseCoopers survey on healthcare information technology.
More than 41% of survey respondents are with organizations that already have made some investment in EMRs, up 10 percentage points from one year earlier. A total of 80% indicated they plan to invest in technology for clinical records by 2005.
For the first time in the six-year history of the survey, half of the responding organizations have physicians who use computers for patient records, either within their own practices or at hospitals where they have staff privileges. The 50.5% usage rate is nearly double the 2001 rate of 27.3%.
Predictably, adoption is lower among independent medical groups than for hospitals or hospital-affiliated practices; 61.4% of hospital respondents say their institutions have made the investment, compared with 50% of physician leaders surveyed from medical groups affiliated with nonhospital companies-e.g., laboratory services companies, PPMs and locum tenens providers. Of the physician executives from independent group practices, 36.7% say they have invested in an EMR.
"The big players in our area are moving at one degree of speed or another to get physicians to use electronic medical records," says Ray Mummery, M.D., CMO of Dimension Health, a Miami-based PPO that serves about 400,000 enrollees in South Florida. "As we move toward that, the doctors are going to find that it will improve their ability to render care."
However, investment does not necessarily translate into system completion and usage, as connection within a large organization takes time. "I thought electronic records were just around the corner for everybody back in 1986 and '87," says Michael Gorczynski, D.O., the director of medical informatics at Aurora Health Care, a 13-hospital not-for-profit health system in Milwaukee that has about 750 employed physicians.
Aurora has collected 60 million laboratory results in its electronic databases since 1986, Gorczynski says, but just this fall moved to a full EMR at its largest facility, St. Luke's Medical Center. Its outpatient clinics will not be fully wired with a Cerner Millennium system until the end of 2004, he says.
Two years ago, Daniel Hier, M.D., chief of neurology and physician adviser to the information technology services department at the University of Illinois Medical Center at Chicago, told Modern Physician that the 600 physicians at the academic medical center would be able to create and view patient charts on personal digital assistants within a year or two. That still has not happened.
In many circles, automating clinical documentation has proved to be even trickier than implementing computerized physician order entry.
UIC has achieved 100% inpatient CPOE but still has not gone electronic with its nursing documentation because nursing has hundreds of specialized forms.
"That's been the sticking point," Hier says. "The first thing you have to do is remove all the duplicate and redundant forms."
But all the effort has been worth it, Hier says.
"With an electronic record, you can document better. You can bill a higher level of service because you have the documentation to back it up."
Improved documentation, it is said, can help reduce liability risk at a time when rising malpractice insurance premiums are causing many physicians to practice defensive medicine and consider early retirement.
"I know in the past we've lost (malpractice) cases because the documentation has been lost or we couldn't produce the documentation," Hier says. "That doesn't happen anymore."
A more recent twist-and one that adds to implementation time-is the integration of clinical and administrative functions through the EMR. Successful integration can improve practice efficiency and contribute to greater patient satisfaction.
In particular, automated scheduling created a good deal of buzz at last month's Medical Group Management Association conference in Philadelphia.
Murray Hill Medical Group, a 34-physician primary care practice affiliated with New York University, now links its EMR and practice management system with an online scheduling program that allows patients to choose appointment times over the Web.
The EMR also can send patients reminders by e-mail if they are overdue for an office visit.
"The thought of allowing patients into a scheduling book to make their own appointments is way out there," admits Jeffrey Friedman, M.D., Murray Hill's managing partner.
But the radical thinking has paid off. Friedman says the electronic link has allowed the practice to reassign five of its 20 full-time employees who previously had done little more than answer phones.