Goetz Goldberg D, Kuzel AJ, Feng LB, et al. "EHRs in primary care practices: benefits, challenges, and successful strategies."
Reference
Goetz Goldberg D, Kuzel AJ, Feng LB, et al. EHRs in primary care practices: benefits, challenges, and successful strategies. Am J Manag Care 2012 Feb 1;18(2):e48-54.
Abstract
OBJECTIVES: To understand the current use of electronic health records (EHRs) in small primary care practices and to explore experiences and perceptions of physicians and staff toward the benefits, challenges, and successful strategies for implementation and meaningful use of advanced EHR functions. STUDY DESIGN: Qualitative case study of 6 primary care practices in Virginia. METHODS: We performed surveys and in-depth interviews with clinicians and administrative staff (N = 38) and observed interpersonal relations and use of EHR functions over a 16-month period. Practices with an established EHR were selected based on a maximum variation of quality activities, location, and ownership. RESULTS: Physicians and staff report increased efficiency in retrieving medical records, storing patient information, coordination of care, and office operations. Costs, lack of knowledge of EHR functions, and problems transforming office operations were barriers reported for meaningful use of EHRs. Major disruption to patient care during upgrades and difficulty utilizing performance tracking and quality functions were also reported. Facilitators for adopting and using advanced EHR functions include team-based care, adequate technical support, communication and training for employees and physicians, alternative strategies for patient care during transition, and development of new processes and workflow procedures. CONCLUSIONS: Small practices experience difficulty with implementation and utilization of advanced EHR functions. Federal and state policies should continue to support practices by providing technical assistance and financial incentives, grants, and/or loans. Small practices should consider using regional extension center services and reaching out to colleagues and other healthcare organizations with similar EHR systems for advice and guidance.
Objective
To understand the current use of electronic health records (EHRs) in small primary care practices and to explore experiences and perceptions of physicians and staff toward the benefits, challenges, and successful strategies for implementation and meaningful use of advanced EHR functions.
Type Clinic
Primary care
Size
Small and/or medium
Geography
Urban, suburban, and rural
Other Information
Small primary care practices with 1-9 physicians in Virginia.
Type of Health IT
Electronic health records (EHR)
Type of Health IT Functions
EHR functions varied between 6 practices. Listed functions include problem list, ambulatory visits, emergency visits, specialist visits, inpatient visits, connection with hospital EHR, medications, radiology findings, medication ordering reminders and/or drug interaction data, laboratory findings, automatic lab data, clinical guidelines, patient registries, e-prescribing, patient electronic access to scheduling appointments and patient access to EHR.
Context or other IT in place
All practices use EHRs to input ambulatory care progress notes, patient problem lists, medications and allergies, and lab results. Several have electronic connections with hospital EHRs and clinical decision support tools.
Workflow-Related Findings
Practices that experience smoother transitions in implementing advanced EHR functions plan for changes in roles and responsibilities, redesign, work processes, and develop up-to-date policies and procedures.
Most practices did not proactively redesign work processes around new EHR functions. Practices reported difficulty changing work processes to support EHR functions and difficulty customizing templates and EHR features to meet practice needs. Incorporating new functions often resulted in slow implementation, disruption of patient care and limited use or non-use of these functions. Physicians and staff reported difficulty following new work processes, lack of understanding the rationale for function use, and being unwilling or unprepared to learn new skills.
Study Design
Only postintervention (no control group)
Study Participants
6 primary care practices in Virginia with existing EHR. 38 individuals participated: 14 physicians, 10 nurses, 3 medical assistants, 8 managers, 2 QI staff.