Viewpoint

EHR: The Eagle Has Landed

From The Chief Medical Editor
Larry E. Patterson, MD

Twenty-three years ago, I started my career as an ophthalmologist in solo private practice. Three years later, I built my first office. I had heard about electronic medical records—an exciting new idea at the time—so I installed conduit throughout to make the wiring easier once we implemented EMR.

By 2002, our practice's growth required a larger facility, one with a surgery center. Again I put conduit and even blocking in the walls, preparing for the inevitable EMR, which has now become EHR, or electronic health records instead of medical records—allegedly a more accurate name, but one with an unfortunate side effect: my computer spell-check keeps changing EHR to HER!

If you regularly read my column (and again, Mom and Dad, I thank both of you for doing so), you know that I have wanted EHR for years, but procrastinated due to cost, uncertainty (about almost everything), and the simple fact that it seemed to slow down every practice that used it. Not to mention the substantial attrition rate, which weighed heavily on my mind.

That's all finally changed. By the end of the year, I hope to be fully operational with one system that includes EHR, practice management, optical and ASC software. NASA put a man on the moon in a decade. Why has it taken me twice as long to adopt something I wanted in the first place? Put another way, what has changed about the EHR proposition that makes it finally worthwhile?

There's no single reason. As you know, our government pays a substantial bonus for implementing EHR over the next few years, followed by penalties for noncompliance. But looking at the costs of implementation, including software, support, hardware, doctor and staff down-time, and emotional frustration, I urge you not to do this just because of the money. That alone won't justify it. It did, however, accelerate the timing of my decision.

No, I'm doing it for many other reasons. First of all, the products have improved. I chose a vendor (not the largest, but large enough to have longevity), who claims that no doctors have ever returned its product. That compares to some others with a 10 to 30 percent dropout rate. I talked with doctors who have been using this product and found that it only took a few weeks using the software to be up to their previous full speed using paper records. Doctors with other systems told me it took them 18 months to three years to recover.

There are many other reasons I finally pulled the trigger, but the biggest came from my staff. Apparently I wasn't listening all this time, but they began to impress upon me how difficult it is to find lost charts, especially now that we have multiple locations. With five offices, five opticals and a surgery center, it was just getting out of hand. When a chart went missing, there seemed to be at least 25 different areas the staff had to look. I have no idea how much this alone has been costing me—and frustrating them.

While I'm happy with my decision so far, understand that I've not seen my first patient using EHR just yet. I'll check back in with you after the first of the year. And hopefully, my headline won't be, “Houston, we have a problem … ”