EMR implementation is no small feat for any healthcare organization. Small practices, in particular, tend to really struggle in not only ditching paper in the first place, but also in optimizing the technology once they've purchased it.

Despite the government's rewards and not-too-distant penalties to encourage EMR adoption, a recent article from Kaiser Health News highlights some serious concerns among small-group physicians about when and how to make the investment. For example:

• Will a modest system purchased by a small practice be able to talk to the hospital's EMR system?
• How severe are the hidden costs and upgrade expenses?
• How is a practice to choose among the 570 different electronic health systems certified by private organizations for non-hospital settings may be used to qualify for the meaningful use bonus?
• How to avoid being sold a system that will become obsolete?

"I don't want to be stuck with something that seems easy but isn't going to work as time goes on," Dr. Sandra Berglund, a solo family medicine doctor, told KHN.

Meanwhile, a national study of small and midsize physician practices published in Health Affairs reveals that even once they're up and running with an EMR, most of these groups fail to make the most of their investment.

In general, the survey of practices ranging from one to 19 doctors shows that, on average, they use only about a fifth of the care processes that specialty societies have defined as essential components of the patient-centered medical home, InformationWeek reports.

More specifically, less than 19 percent of the small practices did e-prescribing, compared to 28 percent for all of the groups. Registries also remain very rare (6%) among very small practices compared to 34 percent of practices in the 13-to-19-doctor range that use registries to track and reach out to patients who needed preventive or chronic care.

According to Steven M. Shortell, dean of the School of Public Health and professor of health policy and management, University of California at Berkeley, small physician groups need leadership and technical assistance to surmount the obstacles to implement full EHR implementation, predicting that federally funded regional extension centers would play a large role.

Despite their clear need for help, however, only 31,000 small group practices have registered so far with RECs, according to KHN. Part of the resistance, as FierceEMR reported previously, may be the $100 to $2,200 annual cost to practices that contract with RECs. However, considering that upfront EMR costs can be as high as $20,000 per doctor, not including technical support and upgrades, reaching out to RECs may be a worthwhile investment for small practices.

To learn more:
- read the article from Kaiser Health News
- check out this study abstract from Health Affairs
- see this article in InformationWeek

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