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Exploring Barriers to Implementing Electronic Medical Records in Primary Care Practices

Amrita Parmar

HIMA 5060- Final

Fall 2012-Dr. Zeng

Introduction Obesity and chronic disease are major concerns faced

by primary care physicians. CDC (Centers of Disease Control and Prevention) reports one third of the adult population in the United States is obese (35.7%) 1

Health conditions are a burden in terms of cost, providing care, and patient management. 1 Primary care physicians are first contacts for patients, resulting in health burden placed upon primacy care physicians 2

Adoption of health information technology may solve this increasing pressure2

Electronic Medical Record (EMR) is a systematic collection of health information pertaining to individual patients medical history. 3

Background Many advantages to implementing EMR found in literature

however, implementation is very low. Only 4% of primary care providers have fully functional EMR systems and 13% have a more basic system. 12

Implementation of EMR systems could lead to efficiency, quality and quantify of care provided

Traditional method: paper-based medical record; leading to space consumption and delay access to medical care. 4

Paper-based method less efficient due to increase of health burden and need for care

The EMR system allows multiple users to access the patient record creating legible and organized recordings of a patients medical history. 4

Findings Barriers to implementing an EMR system in a

primary care practice: Financial Cost Technology Time Patient Record Privacy Quality of Patient-Physician Interaction

Financial Cost Physicians weigh the cost of implementing EMR with benefits and

return on investment Start-up cost (purchase of hardware and software, installation cost) Ongoing cost (technological support, administration of system and

maintenance)

Return on investment is not seen until months into implementation

Primary care facilities may have to put in a large sum of money at start-up

McGinn, C. A., et al. (2011) reported 19 (out of 52 studies corresponding to 60 publications) considered cost as a major issue of EMR implementation in their systematic review

Training healthcare professionals can require cost to hire system operations personnel

Size of practice (smaller primacy care practices may be more reluctant to implement EMR due to high costs)

Technology Basic computer skills are necessary in operating an

EMR system

Primary care physicians may lack technical skills

Physicians need to quickly record information that the patient is providing to decrease (or keep the same) the time spent on each patient, prior to implementation of the system

Issues: hardware, server, network malfunctions, system not providing the promised results can cause delay 7

Difficulty in reaching support personnel leading to Primary care physicians getting technical support from other support agencies at a higher cost. 2

TimeTwo parts:

Physicians believe EMR system will increase time spent on each patient and the system may not be as reliable, efficient has completing paper charts.

Time needed for implementing the EMR system into the practice and time taken to start using the system efficiently. Even after implementation access to technical support, incase issues arise, can also affect time.

Patient Record Privacy Primary care physicians concern for patient

record privacy: Lack of overall clear security standards that can

be followed upon implementation. 4 Inappropriate disclosure of medical records

leading to legal issues. 4 McGinn et al. reported that physicians reported patient record security as the second most mentioned factor in the systematic review (21 of the 52 studies). 5

Quality of Patient-Physician InteractionsQuality of are may decrease due to the use of an

EMR system

Physicians inputting detailed notes while in the examination room with the patient

Impact the amount of attention provided by the physician to the patient 5

Paper-based system allows physicians to write as much or as little and they think necessary

Loss of individual practice style for the physician due to following EMR template

Conclusions In order to meet the needs of an increasingly unhealthy

population, EMR systems need to be implemented

Barriers faced by primary care practices must be assessed and successful implementation strategies need to be found

Health system stakeholders cannot expect our healthcare systems to perform if solutions to barriers do not exist. 6

This paper explored barriers to EMR system implementation in primary care practices. The barriers reported on included: financial cost, technology, time, patient record privacy and quality of patient-physician interaction.

Recommendations

Financial cost could be government funding or subsidized cost for practices that treat Medicare and or Medicaid patients

Primary care physicians that provide care to state or federal plan carriers could be compensated for implementing EMR systems. 4

EMR system developing companies, offering better customer support, could resolve technological issues

Primary care physicians should look into systems that are best suited for their practice.

Patient privacy can be protected under the Health Insurance Portability and Accountability Act (HIPPA). 4 This act can protect the handing and transporting of health records from physician to patient, one medical facility to another, or anywhere where records need to be transported

Physician patient interaction can be improved by proper position of monitor in the examination room

If funds are available purchasing a tablet could be effective in entering data while providing care to patients

References 1 The Centers of Disease Control and Prevention. (2012). Overweight and Obesity. Adult Obesity Facts. Retrieved from:

http://www.cdc.gov/obesity/data/adult.html

2 Ludwick, D. A., and Doucette, J.(2009). Primary Care Physicians’ Experience with Electronic Medical Records: Barriers to Implementation in a Fee-for-Service Environment. International Journal of Telemedicine and Applications. 853524(9). Retrieved from: http://www.hindawi.com/journals/ijta/2009/853524/

3 Vanek, V. W.,(2012). Providing Nutrition Support in the Electronic Health Record Era: The Good, the Bad, and the Ugly. Nutritional in Clinical Practice. 27(718). Retrieved from: http://ncp.sagepub.com/content/27/6/718.full.pdf+html

4 Boonstra, A. and Broekhuis, M.,(2010). Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Services Research. 10(231). Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924334/pdf/1472-6963-10-231.pdf

5 McGinn, C. A. et al.,(2011).Comparison of user groups’ perspectives of barriers and facilitators to implementing electronic health records: a systematic review. BMC Medicine. 9(46). Retrieved from: http://www.biomedcentral.com/1741-7015/9/46

6 Ludwick, D. A. and Doucette, J.,(2009). Adopting electronic medical records in primary care: Lessons learned from health information systems implementation experience in seven countries. International Journal of Medical Informatics. 78(22-31). Retrieved from: http://www.mece.ualberta.ca/~doucette/Publications/Ludwick-Doucette-IJMI-2009-EMR.pdf

7 Tonnesen, A. S.,(1999).Electronic Medical Record Implementation Barriers Encountered During Implementation. AMIA, Inc. 1091-8280(99). Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2232660/pdf/procamiasymp00004-0661.pdf

8 Pizziferri, L. et al.,(2005). Primary care physician time utilization before and after implementation of an electronic health record: A time-motion study. Journal of Biomedical Information. 38(176-188). Retrieved from: http://ww.marcomannino.com/healthcare/articles/time_motion_emr.pdf

9 Rind, D. M. and Safran, C.,(1994).Real and imagined Barriers to an Electronic Medical Record. AMIA, Inc. 92(0195-4210). Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2248479/pdf/procascamc00002-0100.pdf

10 McDonald, C. J.,(1997). The Barriers to Electronic Medical Record Systems and How to Overcome Them. Journal of the American Medical Informatics Association. 4(3). Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC61236/pdf/0040213.pdf

11 Were, M. C. et al.,(2010).Evaluating a scalable model for implementing electronic health records in resource-limited settings. Journal of the American Medical Informatics Association. 17(237). Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995711/pdf/amiajnl2303.pdf

12 Mostashari, F. et al.,(2010).A Tale Of Two Large Community Electronic Health Record Extension Projects. HealthAffairs. 28(2). Retrieved from: http://content.healthaffairs.org/content/28/2/345.full