Dr. Everest Whited spoke openly and eloquently to the issues surrounding adoption of computer systems in small or unaffiliated practices. One of the issues is time and the other is supportwe have already heard about the cost.
A benefit to adoption is the rapid increase in medical knowledge and how physicians can tap into the fast-paced learning required to stay on top of research. Having decision support at your fingertips would be a great benefit, not only to the physician but also to the patients. There is definitely a learning curve, but as Whited mentioned, most physicians do have some knowledge of a computer, be it gaming or Internet searching. Basic knowledge of functionality is there, but certainly implementing an electronic medical record takes much more trainingthat is accurate. Successful EMR implementations include a training period for physicians prior to bringing up the system into a "live" environment. Support should be in the form of small group (all staff) training and/or one-on-one physician time at their convenience.
Another issue is the level of training required to implement an EMR. While some approach EMR training as a complete system overview requirement, I believe initial training should focus on the critical functionality. Identify what the physician needs in the examination room or immediately outside the exam room in order to view and document visit essentials. In smaller group practices this is a challenge because of the lack of on-site support. Beyond initial sharp-end training, the physician can explore other functionality as their comfort level increases. For example, many systems have robust library functions where you can look up diagnoses or access printable patient information online from a link within your EMR. Although valuable, it may not be the most essential functionality in the beginning. First learn to use and view patient information, laboratory results, allergies/intolerances, diagnoses, and, of course, medications. Keep it simpleit can be.
The EMR should be a tool, a documentation system for patient records that may be accessed every day or in an emergency (Hurricane Katrina). If the concept of electronic records is viewed as an innovation (that is here to stay) that supports improved outcomesdecision support, patient education tools, patient engagement through PHRs, extensive access to journals online through medical libraries, etc.then perhaps physicians will become more comfortable accepting the science and look for positive ways to adopt. Having said that, it is not initially easy, nor is it inexpensive and EMR vendors need to step up to the plate with products for smaller physician practices that provide value, are intuitive and don't empty the bank. I am very sympathetic to the issues presented by Whited and others. In the long run, the benefit is definitely worth the pain, but we do not yet have truly adequate solutions for all.
Linda CenterProgram managerPeaceHealth Eugene, Ore. To submit a letter to YOUR VIEWS, click here. Please include your name, title and hometown.