Over the past decade, EHR implementation and optimization have gained a foothold in cardiovascular practices, even in smaller practices. Some cardiologists find going paperless lightens their administrative burden. But to maximize benefits, practices must roll out implementation carefully and anticipate bumps in the road.
Slightly more than half of all U.S. cardiology practices have moved toward some form of electronic documentation, according to a survey by the Medical Group Management Association (MGMA). There are a number of factors driving this shift: the need to integrate with a hospital's record-keeping system; inefficiency of paper records and problems associated with secure storage; the wish to maintain a modern practice; and the Health IT for Economic and Clinical Health (HITECH) Act, which offers financial incentives for Meaningful Use of health IT, specifically EHRs.
According to MGMA’s 2011 “Electronic Health Records: Status, Needs and Lessons” report, 52.3 percent of the respondents used an EHR, while 35.8 percent maintained paper charts. The results for cardiology practices were similar, with EHRs implemented to varying degrees in 60.4 percent of responding cardiology practices and 34.6 percent reporting use of paper charts.
Cost and fear of lost productivity are two factors survey respondents cited most often when explaining their continued use of paper records. Private practices can expect EHR acquisition and installation costs of $40,000 to $50,000 per physician, and maintenance costs of up to $5,000 per physician, per year, says Jerry D. Kennett, MD, a cardiologist at Missouri Heart Center in Columbia, Mo., and chair of the American College of Cardiology's Advocacy Steering Committee. Even so, the MGMA report indicates that 62.9 percent of paper record keepers plan to seek the financial rewards the HITECH Act offers, which can be substantial. The Medicare EHR incentive program, for instance, provided up to $44,000 to eligible professionals over five years if they began participation by 2012.
“The reality of the future is that you will need an EHR to participate in the various payment models,” says Kennett. It may seem that the push to implement EHRs is yet another example of bureaucratic interference with the efficient, compassionate practice of medicine; however, the examples of practices that have successfully implemented and optimized EHR do not support that notion.
Practices that have fully implemented EHRs say that, if done properly, the EHR can lead to efficiencies and improved quality of life for physicians. A 2010 study found that physicians spent an average of four hours per week providing documentation and other information to third-party payers (Health Aff 2010;29:1248-1254). Reducing the amount of time that physicians need to spend on responsibilities not directly related to patient care can be a benefit of an EHR system.
Samir B. Pancholy, MD, an interventional cardiologist and director of the cardiac cath lab at Regional Hospital of Scranton in Scranton, Pa., is a big fan of his hospital’s EHR system, saying that it has reduced the time he has to spend on documentation. “There is much less duplication and redundancy, and I am able to engage with my patients. I can make eye contact and be present with them, and stop worrying so much about getting all the information down,” he says.
Pancholy had several cardiac nurses whose primary duty was documentation. “This was such a waste of highly trained, intelligent people who could have been contributing to patient care,” he says. “And highly inefficient, because often I also would have to document the same thing the nurses had already documented.”
When his hospital implemented its EHR system, staff from the cardiac unit was involved from the beginning. They had input into the template design, ensuring that the fields were appropriate and made sense in the context of practices.
Pancholy also appreciates the ease with which the cath lab's EHR interfaces with a quality improvement toolkit he uses. The two systems work together in a way that permits him to track performance, collect and collate data, as well as promote best practices. “[It is] a great help in getting the system to work most effectively for the patients and for the entire cardiology unit, physicians, nurses and everyone involved,” he says.
Transitioning is difficult
Although EHR adoption went well in Pancholy's practice environment, his experience