Some call them Electronic Health Records (EHR), and some call them Electronic Medical Records (EMR); they are, for all intents and purposes, the same: a system for physicians to store patient information that allows for better billing and a more efficient clinical practice.

Since it is generally agreed that EHR is a better way of doing things, why are more physicians not switching over?

The cost of converting to an EHR system is one big hurdle.

“I’d think that $70,000 for an office to convert is on the low end,” said Kari Cassell, chief information officer at UAMS. “I’d think that someone would be looking at $80,000 or more likely $90,000 when you consider what has to be added.”

The other part is just a general reluctance for change.

“It’s a culture change,” Cassell said, “that’s the biggest part of the project.”

And changing workplace culture can be difficult, never mind the challenges that some of the more rural areas in Arkansas face, like the lack of Internet access.

But converting to EHR takes more than just a fast Internet connection and picking up a new computer and somesoftware that can be picked up at Best Buy.

For one, the software is so specialized that it has to be purchased from a vendor. While several programs are available, one program in common use is GE’s Centricity package. Components of it can be used for more than just EHR, but also the popular PACS program for imaging, along with things like practice management.

GE claims that Centricity, which UAMS uses, is the system in widest use.

“There’s always dueling systems…,” Cassell said, “but that makes our integration efforts more important. We put a lot of time and energy into making sure any system that we sign a contract for is integrated and interfaced throughout our system.”

The decision to go to EHR isn’t easy. “You have to have physician buy-in,” said Linda Coleman, who also works with technology at UAMS.

“Absolutely,” Cassell agreed. “When the physicians are the driving forces, it’s really a success.”

It takes more than that, though.

A 2005 Washington Post article detailed the troubles at Cedars-Sinai in Los Angeles.

There, a $34 million electronic system was shelved after, as Ceci Connolly wrote, “only a fraction of the 2,000 doctors with privileges at the hospital were involved in developing the system, even though they faced a dramatic change in the way they practiced medicine, from jotting notes on a clipboard to logging onto a computer to type in their treatment and medication orders.”

The article described the hospital’s approach as being “big-bang,” as in doing it all at once. Cedars-Sinai’s “big-bang” conversion is viewed as the wrong approach.

“We are doing it little by little,” Coleman said. “We are using a phased-in approach, so we don’t hit them all at once.”

“It’s a very difficult transition,” Cassell said of the switch to EHR. “You really have to decide what your organization can handle. And our organization, we pushed the change as hard as we could. But without having physician support, you are asking for trouble.”

But when you have physician support and have mastered all the technical aspects, it can be a harmonious convergence, as UAMS has found.

“Once (our doctors) get three months down the road” Cassell said, “they’re going ‘don’t let this go down. We couldn’t do (our job) without it. How would I do my job without it?’ And the whole mentality starts to change, instead of pushing to get it in, they are pulling and you can’t deliver it fast enough and that’s so cool.”

But why the push for EHR?

Well, for one, President Bush in his 2004 State of the Union address said that it was one step in a multi-step plan to improve American healthcare. In the address, President Bush said, “By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care.”

Locally, the Arkansas Foundation for Medical Care (AFMC) has been leading the way for EHR.

The AFMC program started in the spring of 2004 (after President Bush’s address) and involved around 460 physicians at more than 250 sites around the state in a pilot project.

An AFMC press release said the project was the largest of its kind in the United States at the time.

AFMC, as Arkansas’s QIO (quality improvement organization), has been working with the Centers for Medicare and Medicaid Services to improve EHR around the country.

10 Keys to Successful Transformation

• Define a vision for the future and know your current state by analyzing market, culture, technology, community needs and opportunities for improvement.
• Develop a communication plan to reach all levels of the organization.
• Visibly champion the cause showing strong leadership involvement and support.
• Build internal skills to solve problems and lead change efforts.
• Seek early, measurable wins to build momentum, overcome skepticism and encourage participation.
• Take a balanced, holistic approach to ensure gains in one area don’t cause problems in another.
• Reach out and learn from others who have embarked on similar initiatives — whether inside or outside your industry.
• Establish alignment and accountability by linking major goals and core business metrics to projects and performance.
• Create monitoring mechanisms to ensure results are maintained.
• Recognize, reward and celebrate success on a regular basis!

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