Electronic medical records are a huge expense for independent spine practices and require several hours of installation and training.
However, almost all hospitals now include some form of electronic patient record system and new government regulations for quality reporting make it nearly impossible not to implement.
An August 2012 Medscape report shows that 74 percent of physicians are using EMR and another 8 percent were in the process of installing them. Others said they had plans to install an EMR over the next few years and only 6 percent said they would not be implementing a system in the foreseeable future.
Jeffrey Carlson, MD, president of Orthopaedic and Spine Center in Newport News, Va., implemented their first EMR around 10 years ago, which eventually resulted in "a better allocation of resources from paper management to electronic management." The system was expensive, but he said over three years they were able to recoup the expense with improved workflow and patient flow.
"Unfortunately, we grew to rely on this system but it did not meet the current government requirements and we had to buy a new system three years ago," he said in a Becker's Spine Review report. "The transition was much easier this time as it was only a transfer of information and storage arrays which was able to be done over a weekend. There were, of course, some bumps in the road, but these have been minor. The new system does maintain our records cleanly, and we hope to recoup the finances over the next year."
The transition from paper records to electronic records isn't easy and requires a tremendous amount of upfront data entry to bring the electronic system up to speed. Around 26 percent of the physician respondents in the Medscape report said the EMR decreased productivity. Only 6 percent said the system increased practice revenue. Additional concerns with the impact of EMR on patient-physician relationships has been raised.
"Unquestionably EMR has altered the doctor-patient relationship," said Kern Singh, MD, co-founder of the Minimally Invasive Spine Institute at Rush University Medical Center in Chicago in a Becker's Spine Review report. "More of my time is now spent charting electronically throughout the day. This increase in administrative paperwork results in a decrease in direct patient interaction. The challenges of medicine are placed upon the physician and ultimately the patient."
Despite the challenges for EMR implementation, many physician groups have purchased systems and attested Centers for Medicare and Medicaid Services meaningful use. The program provides incentives for providers to demonstrate the meaningful use of certified electronic health records. Stage 1 Meaningful Use incentives were available from 2011 to 2012; stage 2 and stage 3 attestation deadlines are 2014 and 2016, respectively.
According to a HIMSS survey released in June, around 60 percent of physician groups have successfully attested to stage 1 of meaningful use and 48 percent have received incentive payments.
Practices implementing the new system must also train physicians, nurses and staff on the different functions. The typical cost is $10,000 to $35,000, according to the Medscape report, and web-based EMR providers typically charge less than $300 to $500 per month. There are several EMR platforms available and most offer customizable options, but some are better for smaller practices than others.
The most popular EMR for physicians was Epic, used by 22 percent of the respondents in the Medscape report, although the highest rated system for small practices of one to 25 physicians was Amazing Charts. The surgeon partners of BASIC Spine in Orange, Calif., designed their own EMR to fit with back pain patients and improve their practice processes.
"We are able to capture some of the data that is unique to back pain practices and incorporate our best practices into EMR," said BASIC Spine founder Ty Thaiynanathan, MD, in a Becker's Spine Review report. "We can also collect data from the patients about what they've tried and compare their results to data that has been published before determining the best treatment pathway. We are able to more efficiently treat patients — we've actually cut time down by half — and still deliver the same amount of patient face time because we are spending less time on documentation."
This information could become even more useful as consumers and payers demand more evidence of quality and cost-effectiveness in healthcare. CMS has released the Physician Quality Reporting System, which uses a combination of incentive payments and payment adjustments to promote the reporting of quality information from eligible providers. The 2015 payment adjustments are based on 2013 program year data. Group practices can also qualify for PQRS incentive payments.
While many healthcare providers have begrudgingly accepted EMR over the past few years, a new strategic report from the Rand Corporation and sponsored by the American Medical Association shows that some may be relaxing their ire. Physicians are still feeling a tremendous burden from new rules and regulations associated with meeting meaningful use — with data-entry being time consuming and interfering with face-to-face patient care. However, physician respondents approved of EMR conceptually and approved of the ability to access patient information remotely.
Physicians can access patient records through a variety of secure systems in almost any location with internet access, even with mobile devices.
"Some systems include online patient portals allowing patients to input their own health and history data prior to their appointments," said Hamid Mir, MD, an orthopedic spine surgeon at DISC Sports & Spine in Marina Del Rey, Calif., in a Becker's Spine Review report. "The patient fills out their history and every time they come in, they'll update with any changes to medications or other conditions. Additionally, if they are admitted to a hospital or experience another significant change with their health, we are notified. If an older patient is taking blood thinners they forgot to mention in their histories, it's nice to capture that electronically."
EMR has also made it easy to keep other specialists and primary care physicians informed about the patient's progress during treatment. "The EMR allows us to copy everyone else involved on the patient records, which are sent to them as soon as the patient is seen," says Dr. Mir. "The advances in EMR systems are really making information transfer more accurate and allowing us a safer way to practice medicine."
So, is EMR a worthwhile investment for small to medium sized spine groups in today's healthcare environment? Some are still skeptical given the price, upfront inefficiencies, potential negative impact on the patient-physician relationship and the unstable atmosphere of healthcare policy in Washington, D.C. However, healthcare is moving toward a more integrated system and fully-implemented EMR can have measurable benefit for patient care.
More Articles on Spine Surgeons:
A New Spine Surgery Technique to Minimize Blood Loss in Spinal Deformity Correction: Q&A With Dr. Fred Sweet
How Spine Surgeons Can Succeed With Consensus Building: Q&A With Dr. K. Daniel Riew
Spine Surgeon Tinkerers: A Dying Breed?