Ambulatory care and adoption issues are focus of electronic medical records conference

The electronic medical record is a hot topic in hospital boardrooms, the halls of Congress, and among physicians. At its annual spring congress, the American Medical Informatics Association addressed the subject of the electronic medical record in ambulatory care. In discussions of broader issues such as EMR product certification and the EMR adoption gap as well as in nuts-and-bolts analyses of EMR implementation, the conference offered attendees a wealth of information and practical advice. The meeting took place April 11-13 in Boston.

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How to Choose and Implement an EMR: The first step for a hospital that wants to reap the benefits of an EMR is to choose and implement a system. The process is fraught with the possibility of failure, and navigating through it is arduous for many practices, especially small ones.

Attendees at the AMIA conference benefited from informative plenary sessions on practical EMR implementation topics and interactive workshops in which they could discuss their own experiences as well as learn from others.

The EMR Adoption Gap: EMR adoption rates in the U.S. are nowhere near optimal, according to speakers at the conference. Substantial implementation will be needed if the country is to meet President Bush's stated goal that half of all hospitals will implement an EMR in the next 10 years and every patient will have access to an EMR by 2014.

According to John Glaser, CIO and vice president of Partners HealthCare in Boston, even as Partners' academic facilities approach 60% to 70% EMR adoption, community hospitals and smaller physician practices struggle to achieve 10% adoption rates.

This adoption gap is not caused by lack of technical know-how, Glaser said, but purely by a misalignment of financial incentives. Physicians pay for EMR implementation, while payers and health plans reap the efficiency and financial benefits.

Additionally, according to several speakers, 60% of physician practices in the U.S. are small (fewer than 10 physicians). These practices cannot afford EMR implementation, nor do they have the IT staff or technical know-how to even consider EMRs.

Asymmetric benefits hinder EMR adoption

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EMR Certification: More than 500 vendors market EMR products today. How can practices feel comfortable choosing one? How will they know that a product does what the vendor claims it can do? Dr. David Brailer, the Bush administration's national IT coordinator, says that the government currently has no plans to step into the certification arena. Private-sector organizations such as the Certification Commission for Healthcare Information Technology (CCHIT) must take responsibility for certification of EMR products.

Should certification be assigned to the private sector, or is legislation needed? Mark Leavitt, chair of CCHIT, championed the flexibility of the private sector, which he said could more quickly and efficiently address EMR product certification.

Regardless of who takes responsibility, product certification is key to improving EMR adoption rates, according to several experts.

Certification group struggles against vendor-driven reputation

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Who Does the EMR Really Benefit? AMIA program chair Dr. Blackford Middleton said that providers, who fund EMR implementations, are generally not the ones who enjoy most of the benefits. The payers receive the lion's share of the financial advantages of EMR use, yet they can be slow to provide incentives for implementing EMRs.

The question is how to either shift the burden of EMR implementation costs to those who enjoy the financial benefit, or to shift the financial gains to those who bear the costs.

Speakers at the meeting's closing reactor panel offered suggestions, including the development of low-interest government loans, to address the large capital expenditures associated with EMR implementation.