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Information technology in the medical practice

By Sherry L. Migliore, MPA

According to a 2002 survey conducted by Connecting by Health, a coalition of over 100 public and private organizations, many patients have the perception that their physicians are heavily invested in the use of modern information technology. Forty percent of the individuals surveyed assumed that their physicians and hospitals use electronic medical records, computerized physician order entry, and other technologies to manage their patients’ health care information.

However, industry experts estimate that less than 10 percent of physicians and no more than 20 percent of hospitals use electronic medical records. Another recent survey found that just a little over two-thirds of medical practices used a desktop or laptop computer in at least one clinical area and that only 16 percent of the practices used computers in exam rooms.

Just why is it that the practice of medicine is one of the few businesses today that still keeps the majority of its customer information in paper file folders? And how can a practice ensure that when it is ready to automate, it is making the best possible decisions? The answers to these questions are complex and require thoughtful consideration.

Why have medical practices not invested more significantly in information technology?

Cost. First and foremost, when asked why they have not invested in more advanced technology most physicians reply that they do not feel they can afford the initial capital expense of such an undertaking. A client of our organization that has eight physicians in the practice just received a quote of $250,000 for the hardware, software and training costs to implement an electronic medical record system (EMR). The office administrator remarked to me that while the price decreased significantly from the $400,000 quote they received two years ago, the group has decided to wait at least another year or two to move forward with EMR. It will be necessary for the practice to take out a loan to cover the expense of this investment whenever it occurs.

Time. As described later in this article, the process of selecting technology requires a significant time investment on the part of physicians. Time is a precious commodity for physicians these days, and making the right decision requires a commitment of time (as well as energy)!

The “generation gap.” In some (not all) cases, the older physicians, who have had no problems embracing patient care technology, may be less knowledgeable about information technology and therefore less likely to be receptive to it. It is our experience that practices with two or three generations of physicians often have difficulty agreeing on the need to move forward with these types of expenditures. This may not only be due to a lack of knowledge on the part of the older physicians. In the example cited above, the practice has one physician who will be retiring within the next two years and did not feel comfortable asking this physician to share in the cost for the EMR system so close to the time of his retirement. As a general rule the younger generation of physicians tends to be the catalyst for change with respect to implementation of information technology in a medical practice. This is primarily because of their exposure to some of these technologies such as EMR or PDAs during residency training.

A surprising number of medical practices have only the most basic information technologies, such as those that perform patient scheduling, registration and billing functions. Sometimes, even the groups with the more sophisticated systems often do not utilize the systems to their fullest advantage to better manage the practice. Many practices do not have websites or even email capability. However, the use of personal digital assistants (PDAs) by physicians has become increasingly popular during the past few years, with approximately 70 percent of practices reporting that at least one physician in the practice uses such a device.

Fear of implementation. With the use of any new technology, particularly systems such as EMR that impact the entire practice, implementation can be time-consuming and frustrating. At a conference session on technology’s role in health care, the speaker asked for a show of hands of participants that had implemented EMR in their organizations. All of the participants who raised their hands also indicated that they had experienced a period of turmoil and reduced productivity during the implementation process. Some had experienced this to a greater degree and for a longer period of time than others. Despite this, all indicated they would do it all over again because of the benefits to the practice in the long run.

Lack of credible or demonstrated return on investment (ROI) data. Many information technologies promise that the applications will pay for themselves many times over. Indeed, ROI has been successfully measured and documented for many technologies. However, there is no guarantee that the same results will be obtained in other organizations with different cultural and organizational compositions. With some technologies, ROI is difficult to quantify.

Volatility of the health care information technology market. Some physicians are fearful that they will commit a large amount of money to purchase and implement a technology system, only to find that their vendor will not stay in business for the long term. There is some justification for this concern. Additionally, because of the rapid advances in technology, many physicians simply want to wait for newer, better and perhaps cheaper products to enter the market.

When ready to automate, how can a practice ensure it is making the best possible decision?

Conduct a needs assessment. The practice should determine how information technology fits into the organization’s long-range plans. This requires an analysis of how certain technologies are expected to help their practice. Goals should be set that identify and quantify these expectations. For example, the practice might wish to increase physician productivity. It may wish to improve the management of the practice by the use of specific data and measurement tools. Or, it might want to improve medication management for its patients.

Before purchasing any new technology, the practice should conduct a review of its current technology systems and determine whether they are being utilized effectively. The practice may discover that its current systems will meet its needs if properly utilized.

Conduct research. The next step is for the practice to conduct research into the types of technology that will best meet the needs identified during its needs assessment. There are numerous websites that can be utilized as a starting point. Attendance at seminars can be a useful source of information. Physicians should also talk with their peers to obtain valuable feedback as part of the research process.

Develop a request for proposal (RFP). Once several potential vendors have been identified, the practice should develop an RFP that outlines the goals it wishes to achieve by implementing the technology. Vendors should be requested to provide pricing in as specific a manner as possible, allowing for an “apples to apples” comparison. Hardware and software costs as well as training and maintenance expenses should be identified. Additionally, the vendors should be requested to supply information regarding the history of the organization and information about its financial stability. The system should also be HIPAA-compliant.

Conduct a return on investment analysis. What is important here is to quantify ROI for the practice’s specific circumstances. The analysis should identify how the system impacts the entire practice, not just one area. If, for example it is determined that the system reduces costs in one area of the practice, but increases costs in another area, this information must be carefully weighed. Part of this analysis should also be an assessment as to whether the technology interfaces with other technologies used by the practice, if applicable.

Set up vendor demonstrations. After narrowing down the list to three or four vendors, have them come to the practice for demonstrations. Ask both physicians and staff to participate in the demonstrations. Prepare a checklist that can be used to rate each system in key areas such as user friendliness and ask each individual participating in the demonstrations to rate each vendor using this checklist.

Check referrals. Visit other practices that have used the system. Try to find practices that are not on the vendor’s official reference list and visit those practices as well.

Negotiate the best deal possible. Generally, the first offer made by the vendor is not their bottom line. Too often, practices fail to enter into a negotiation process with the vendor that will result in a “win-win” situation for both parties.

If all of the above steps are followed, the practice can be reasonably sure that it has made the best decision possible. It is also important to remember that information technology assessment in a medical practice is really an ongoing process. Physicians should stay abreast of new advances in information technology just as they have always done with patient care technology.

Sherry L. Migliore, MPA, is Director of Consulting at PMSCO Healthcare Consulting. Located in Harrisburg, PA, PMSCO is a subsidiary of the Pennsylvania Medical Society.

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