Electronic Health Records (EHRs) have been aggressively promoted as a tool to enhance the quality and efficiency of healthcare, but solo or small practices -- which make up about half of U.S. practices -- have been slow to adopt EHR technology. Cost, lack of financial incentives, and confusion about the approximately 200 EHR offerings remain significant barriers. Spring Medical Systems is a Houston-based provider of EHR solutions for small and medium-sized practices. Its standalone software suite, developed by a team of doctors, includes practice management and EHR functions and works on PC, Macintosh, and Linux platforms.
Jack Smyth, CEO of Spring Medical, spoke with Digital Healthcare & Productivity, and argued that small medical groups need easy-to-use, functional, customizable solutions, not expensive EHR solutions that much larger practices might demand. No surprise, that's Spring Medical's strength and target market.
DHP: Do small and medium-sized practices have different needs than larger ones?
SMYTH: Large practices are more focused on the business of healthcare, whereas smaller ones are entirely focused on providing quality medical care. A larger practice also might have more security concerns, as there are more people involved in the day-to-day healthcare practices.
Larger practices often attempt to manage the consistency of healthcare provided by the various physicians in their practice. So they would like to see built into the EHR software ways of making the delivery of medicine more consistent from practitioner to practitioner -- practice standards built into the EHR. But the problem for a small practice is that this structure sometimes gets in the way of providing quick medical care and can potentially reduce the number of patients that a small practice can see if it uses EHR software that is more structured.
Software properties that are necessary for a large practice may be cumbersome for a smaller one. One example is that CCHIT systems require robust security, with users needing an 8-16 character log-on password that needs to be reset every 60 days. In a small practice, five to six people don't want to be concerned about this overly excessive security system; some practices would abandon the software and others would do things like write the password on sticky notes and put it on the monitor -- and how secure is that? But there are ways around this, so a small practice can opt out of this feature if they choose to do so.
DHP: Historically, there has been a high risk of EHR implementation failure. Small practices in particular face budgetary and staffing restraints. What are you seeing in the marketplace now?
SMYTH: Products today are friendlier than those in the past; technology is less expensive and more powerful and easier to use. We expect the abandonment rate to go down drastically [because] the new generation of EHRs are more effective at helping provide quality medical care. But many physicians have heard horror stories of how practices have tried and failed and are leery of EHR technology.
DHP: Small practices can't afford downtime as they move from paper records to the electronic format.
SMYTH: We recommend they continue to use the paper system for six to nine months as they transition. They'll find over time that they are not referring back to the old information as much, then they can take the paper records to a storage facility and check them as necessary. Implementation doesn't have to be a time-consuming process.
DHP: How should physicians choose an EHR from the myriad choices available?
SMYTH: The physician should be the one making the decision, as opposed to the office manager. The IT solution should fit the workflow and the way a physician likes to practice. If a doctor isn't going to use the EHR, the product isn't worth anything.
DHP: You're a member of HIMSS EHRVA (Electronic Health Records Vendors Association), a trade association of vendors that addresses national efforts to create interoperable EHRs in hospital and ambulatory care settings. Give us a progress report.
SMYTH: We're working to make sure the road map of future EHR capabilities are consistent from one vendor to another so interoperability can continue to take place. We have provided a lot of feedback to CCHIT to make sure we have the right standards. One of our recent successes was making sure a standard was defined for interoperability with laboratories before this was made a requirement. Instead of 25-30 standards for receiving data from labs into EHR, thanks to our efforts, there is only one. This is an example of making sure a standard is defined before it is required.
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