The American Recovery and Reinvestment Act (ARRA) encourages physician practices to implement electronic health record (EHR) soft- ware. The law does not necessarily require that a physician implement an EHR, but any phy- sician who does not do so will face a one- to three-percent decrease in Medicare payments, beginning in 2016. Other issues may drive the decision to use EHR technology in your practice. ARRA will al- most certainly entice many practices to imple- ment an EHR. Participating will allow you to share data with other providers in the commu- nity and allow others to take advantage of data managed by your practice. Declining to partici- pate, on the other hand, may reduce your refer- rals if you are a specialist, but also may make it more difficult, if not impossible, to comply with programs such as the Physician Quality Report- ing Initiative (PQRI). Given that there are over 200 different EHR systems on the market, the selection process can be rather daunting, but waiting may result in delays. By 2011 or 2012, many vendors may be overloaded with business and may not be able to begin your implementation soon enough for you to obtain your full funding.
Preparing for a System Selection EHRs in the US have a rich history of lim- ited customization, missing features and failed implementations. Many physicians can tell woe- ful tales of buying what they thought would be practice-transforming technology, only to be disappointed with their purchases. Some systems have had spotty records with basic functionality. The Certification Commis- sion for Health Information Technology, or CCHIT, is an independent, nonprofit organiza- tion which establishes minimum standards of functionality for EHRs. Not every certified prod- uct will be successful in every practice, but every certified product is guaranteed to meet certain standards of interoperability and ro- bustness of design. ARRA funding is available only to implement EHRs that are certified by the CCHIT. It would be exceedingly unwise to choose a system that is not CCHIT-certified. Before you begin to consider which EHR you should use, or even ask your colleagues which system they have considered or installed in their practices, you must understand the re- quirements of your own practice. This should include a review of your practice’s workflow, how information moves through your office, and any clinical requirements or standards you wish to implement using an EHR. You should also consider how you want your EHR to inte- grate into your practice management system. Any EHR will require some changes to your practice’s workflow, both to encompass the re- quirements of the EHR’s operation and, more importantly, to take advantage of the opera- tional efficiency that the system will bring to your practice. When designing your workflow you should first document your current pro- cess, but also consider aspects of your practice that could be more efficient. For example, if you need access to your patients’ health records af- ter hours or on weekends, an improvement to your workflow might be the addition of online access to your records from home. Many systems in the market are designed to work best in certain types of practices. This is another criterion you can use to narrow the list of potential vendors. It’s also a good time to talk to colleagues who are looking for systems, who have purchased systems that work well, or who have purchased systems that do not meet their needs.