DENVER – Loss of productivity is the top worry for doctors thinking about switching from paper medical records to electronic ones, according to a new survey by the Medical Group Management Association.
The online survey drew responses from 4,588 practices, representing about 120,000 physicians.

Of practices still using paper records, more than 78 percent feared there would be a "significant" to "very significant" loss of provider productivity during implementation, and two-thirds (67.4 percent) had similar concerns about the loss of physician productivity after the EHR transition period.

The practices still using paper medical records described the other significant to very significant barriers to EHR adoption as “insufficient capital resources to invest in an EHR” (71.7 percent) and “insufficient expected return on investment” (56.9 percent).

"The EHR incentive program seeks to address implementation costs, a critical barrier to medical groups' adoption of EHRs,” said MGMA President and CEO William F. Jessee, MD. “While the majority of groups plan to have their eligible professionals participate in the program, including those organizations that have not yet implemented an EHR, it is clear that groups face significant system optimization challenges.”
Jessee said he hopes future stages of the incentive program will take into account the difficulties medical groups face in meeting the meaningful use requirements.

The survey found that independent medical practices are more likely to have a fully implemented and optimized EHR than those owned by hospital systems.

“Integrated systems are much more complex environments than independent physician practices and their information systems often have to encompass both in-patient and physician components,” said MGMA Innovation and Research Vice President David Gans, who directed the research.

He said the added complexity, combined with the geographic dispersion of most hospital-based physician practices, has hindered the advancement. In addition to redesigning how patient care is delivered, practices must redesign workflow, more fully use the system’s capabilities, integrate the EHR and practice management systems and fully coordinate system interoperability with systems used by hospitals – all activities that are much more difficult to achieve in hospital systems, he added.

One of the hurdles in optimizing any new technology is adequately training new users. More than half – 53.2 percent of respondents – said they either "mildly" or "severely" under-allocated the training time needed during the implementation of their EHR systems.

What is most often missing is a commonsense approach to workflow – how the typical physician’s day flows as he or she interacts with patients and the practice’s support staff, said Rosemarie Nelson, principal of the MGMA Consulting Group.

 “The EMRs could be better at taking advantage of the well choreographed dance between doctor and clinical support staff to accomplish seeing patients in the office and attending to the aftercare communications (results and calls) associated with taking care of patients,” Nelson said.