A study of small physician practice decision makers found that electronic health records (EHRs) will reduce the number of patients seen per day, thereby reducing the practice’s revenue.
The survey, published recently in the American Health Information Management Association’s Perspectives in Health Information Management publication, included 15 U.S. physicians who have been in their practice for at least five years. None of the survey respondents were in practices with more than four physicians, and all of them were considered “decision makers” in their respective practice.
The respondents reached a consensus that EHRs would reduce the number of patients seen per day, thereby reducing their revenue. Although the panelists limited their discussion on the effect of patient outcomes, their most dominant concern was the loss of face-to-face time with the patient. They felt that the use of an EHR would reduce the focus on the patient and potentially cause physicians to miss medical conditions.
According to recent statistics from the Office of the National Coordinator for Health IT, as of 2015, nearly 9 in 10 (87 percent) of office-based physicians had adopted any EHR, over 3 in 4 (78 percent) had adopted a certified EHR and over half (54 percent) adopted a “basic EHR.” Since 2008, office-based physician adoption of any EHRs has more than doubled.
Indeed, a decrease in patient volumes (47 percent of respondents) and a decrease in patient face-to-face time (53 percent) were the two most pressing concerns when asked, “How do you believe the implementation of an electronic health record system would affect the management of small physician practices? Consider the entire practice operations, including but not limited to the patients, the physicians, and the financial implications to the practice.” At no point in the study did any panelist state that their practice saw an increase in volume.
What’s more, one-third of respondents reported that EHRs could force small businesses out of practice due to cost issues. One panelist noted a recent decision to close their practice and move to a hospital system because they felt their small practice was no longer viable. Others mentioned colleagues who had retired or joined another practice or hospital to avoid the complications and cost of the EHR.
That being said, on the optimistic front, the panelists felt that given sufficient software features and transfer protocols, the cost for medical record management could potentially decrease. Examples of features mentioned were automated processes, streamlined record transfers, and optimized patient portals. Panelists shared that providing a better system for remote access as well as the potential to interact with the patient via a portal system had the potential to improve patient care and possibly reduce unneeded visits for questions that could be handled via messaging.
Security issues relating to hacking and data mining evolved in later rounds as panelists were concerned that technology and legislation had not caught up with the potential security concerns. Several indicated that breaches could result in significant loss of privacy at a level previously unseen
In the end, panelists felt that vendors did not provide realistic outcome scenarios, leading several of the respondents to state that vendors were “simply salespeople” and were not concerned with how the technology would affect physicians. Improvements in patient volumes as a result of specialized training remain a viable research interest. Vendors may reap better sales outcomes if they shift their focus from sales to implementation, the researchers noted.
“The results of this study indicate an avenue for EHR vendors to develop educational avenues to teach physicians how to optimize the EHR as well as to share success stories that demonstrate improved financial impact,” the researchers concluded. They added, “Even with a strong government push for the use of the EHR, physician and patient acceptance and participation will be critical to its ongoing success. At present, neither party is fully on board with the new direction of healthcare delivery, although each remains vitally important. Despite the investments in EHRs and the increase in their adoption, patient engagement continues to lag.”
