AMGA: Medical practices nationwide focus on 'meaningful use' of electronic health records

As medical practices nationwide focus on "meaningful use" of electronic health records (EHRs), the American Medical Group Association (AMGA) reports encouraging findings from a survey of AMGA member medical groups. Although few groups have yet to fully achieve all the benefits they anticipated when they began implementation, virtually all groups now have even higher expectations for the potential of health IT, as a result of their experience.

The survey was conducted in collaboration with the JHD Group, a noted healthcare management consulting and technology firm. Since more than 85% of AMGA member medical groups have already adopted EHRs, this survey focused on use and benefits. Exactly how are groups using EHRs, and what benefits have they achieved in patient care, practice productivity, and clinical quality? Results indicate that these groups view EHRs as essential tools and that experienced users universally expressed increased optimism regarding the value they expect to capture from their continued use of the systems. Experience with the systems has raised their expectations of the impact EHRs will have on clinical quality, patient communications, and office efficiency.

Donald W. Fisher, Ph.D., CAE, President and CEO of AMGA, commented, "It's important to understand what techniques have worked for groups that have led the way in EHR adoption. Other practices can learn from their experience, and it's gratifying to see that these pioneers are now even more optimistic about health IT than when they began their journey. Even the groups that adopted EHRs several years ago haven't achieved everything they originally expected. But our members tend to be systems thinkers with a commitment to patient-centered care, and they now see even greater potential for health IT.

"Groups of all sizes believe that disciplined use of EHRs, including e prescribing and patient registries, not only enhances quality and promotes care coordination. They also see it as critical to improving efficiency and controlling costs."

Hank Duffy, Founder and President of the JHD Group, added, "We are very pleased to partner with AMGA on this survey, and we are not surprised that the participation rate was extremely high. That's because EHRs are so central to the efficient administration of health care today--and to achieving effective clinical integration. Efficient and effective delivery of health care is at the top of the nation's strategic agenda, and there's a focus on health IT, with significant stimulus funding available.

"The foundation of healthcare reform will be based not just on adoption, but meaningful use of EHRs in all delivery settings, including practices, clinics and hospitals. Medical groups participated because they want to know how others are faring and benefitting from their EHRs, and to understand how they can improve."

Respondents included clinical leaders and executives from nearly half of AMGA's 345 member organizations, plus 39 non-member medical groups. More than one-third of respondents have been utilizing their EHR for 5 years or longer, about one-fourth for less than 2 years.

Post-survey phone interviews with selected respondents provided an opportunity to glean in-depth insights regarding actual implementation experiences and organizational issues. Workflow redesign was a consistent theme. Adopting an EHR "is like moving from an ax to a chainsaw," one medical director noted, saying that you can do a better job and be much more productive, but you need a different technique. Many groups reported that EHRs can enhance team-based care. "The EHR … allows for true collaborative care," one practice CEO observed. A physician administrator said, "Our nurses have told me they like 'being a nurse again.'"

Still, there are delicate balances to strike. The physician executive responsible for primary care in a large integrated system said, "The physician now orders everything through the system rather than telling the staff to make orders. It seems like clerical work for the physician, but actually it's good, because the person making the order is also responsible." Several respondents said the EHR was critical to growing the practice. Some focused on workflow efficiencies, others on the ability to recruit young physicians.

Patience and persistence are among the most critical success factors. The groups realizing the greatest benefits from their EHRs are those who introduced functionality in stages, allowing time for physicians and staff to develop proficiency in subsets of capabilities at a pace they were able to absorb. Groups with the longest experience reported greater overall satisfaction and greater success in capturing benefits.

The survey also obtained details on important technical issues such as orders/results interfaces for key diagnostic services and the use of templated documentation and patient problem lists. Integration of advanced functionality like e prescribing, patient registries, and patient portals, requires substantial investment and sustained effort, and ongoing attention to workflow and training is critical.

In active online conversations facilitated by AMGA, members of the group's CMO Leadership Council are sharing experiences and advice on topics such as adjustments to productivity-based compensation formulas during EHR implementation. Many respondents have recalled aspects of the experience of implementation that were painful, but most agreed with one physician executive who said, "Our doctors would never go back. Happy or unhappy, they would never go back."