Doctors Need Hand-Holding

Even so, many physicians remain leery of EHRs. That's largely because they've heard so many failure stories. "I've read that one-third of implementations fail," says Michael S. Barr, vice president of practice advocacy and improvement at the 119,000-member American College of Physicians.

EHRs fail for a variety of reasons--they're slower than paper in the beginning, and the network may not work well. Despite the hundreds of vendors on the market, fewer than 20 can handle the needs of large organizations. And not all vendors know what they're doing. In addition, learning how to use these systems can disrupt the doctor's practice and its workflow, and the whole process may seem daunting to many physicians.

Many early adopters say training is the key to success. EHRs often change a medical practice's basic workflow, even simple things like what to do with a lab report. So it takes time to train physicians and their staffs to use the new systems. Basch estimates that MedStar will take three to six months to train doctors and their staffs before their systems go live. And then once the system is live, MedStar will continue to provide support and follow-up training.

Likewise, CareGroup, which is essentially acting as an application service provider for its doctors, will do intensive up-front training. The key to its implementation, Halamka says, will be full-time onsite support and training for the entire first week after each of its practices starts using the system.

Similarly, the Massachusetts eHealth Collaborative is doing more than just furnishing doctors with hardware and software. It is providing training and support on all aspects of the system, including basics in how to connect the hardware and use the software, through June 2008. And it is seeding the pilot slowly, starting with only eight of the targeted 160 practices. As the pilot began in January, Tripathi estimated it would take 10 to 12 weeks to roll out the systems because the new EHRs need to be integrated with the physicians' existing systems for diagnostics and billing and practice management. Once all of the doctors' systems are up and running, the Collaborative plans to build out the networked health information exchanges. The overall goal is to have everything up and in place in all the networked facilities by July 2007.

Training and ample support will also be central to the health information exchange in Fishkill, N.Y. A. John Blair, who is president of the nonprofit Taconic IPA in Fishkill, has set up a company called MedAllies to implement a health information exchange for 500 doctors in 175 practices both inside and outside the IPA. Five hospitals and two national reference labs already use the health information exchange, primarily for lab results and tests.

MedAllies is now in the pilot stage of rolling out EHRs to more than a dozen practices. MedAllies plans to act as a systems integrator of sorts for these practices, coming in to study the workflow in the office before recommending a system to use, implementing the system and then training the doctors and staff on how to use the systems and adapt their workflow to them. MedAllies' staff is then available to handle further questions, which Blair thinks is a key for small practices; a vendor may do a good job implementing a system, but then it's off to the next customer. "Our certified trainers don't leave town," he says.

MedAllies plans to charge physicians about $US500 a month to host and support the EHRs. But despite that relatively modest cost, Blair says he's going to be conservative and say that 100 doctors or more will be up on EHRs by the end of this year. However, Blair predicts 50 percent of the region's doctors will be using EHRs in three years and close to 100 percent in 10 years' time.

Halamka of CareGroup sees a similar timetable. He predicts it will still take about five years for most doctors in Massachusetts to be using EHRs, and about 10 years nationwide.

"I'm very excited," he says. "2006 is the year where economics and politics and demand [for EHRs] will all coincide."

Michael Fitzgerald is a freelance writer living in Millis, Mass. Please send comments to Executive Editor Alison Bass at abass@cio.com.