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1
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- Mark H. Ebell MD, MS
- Dept of Family Practice
- Michigan State University
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2
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3
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4
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- The barriers to the adoption of EMRs in family practice are more
pronounced than in perhaps any other specialty.
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5
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- It is still very much a cottage industry
- 25% solo practice, 8% two physician practice in 1997 (Family Practice
Management, May, 1998)
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6
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7
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- Transience of vendors
- Use of proprietary, closed standards
- Difficult or impossible to change EMRs
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8
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- A physician base that is drawn to the specialty by an interest in
people, not technology
- Concern that use of an EMR will slow them down
- Concern about security
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9
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- Any age or organ-system
- Practice in multiple locations (ED, office(s), hospital(s), nursing
home)
- Average of 2.7 problems and 8 management decisions with each visit
(Flocke J Fam Pract 2001; 50: 211-6)
- Less time per visit: median 15 minutes (Flocke)
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10
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11
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- Development and/or endorsement by an institution would provide at least
the perception of stability
- Use of open standards for database storage and communication and/or open
source software design will assure portability even if a vendor fails
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12
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- Differential reimbursement for physicians using an EMR
- Must use open database standards and taxonomies, incorporate
evidence-based decision support, and electronic prescribing to reduce
medical errors to qualify
- Being advocated by the Leapfrog Group.
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13
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- Or...the EMR must be cheap enough to reduce the perceived financial risk
- Or all of the above: AAFP initiative to develop an open source EMR at
$1500-$2000 per physician
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14
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- Much of primary care involves the evaluation of patients with poorly
differentiated symptoms
- Sometimes a definitive diagnosis is never made (e.g. dyspepsia,
non-specific abdominal pain, acute cough).
- The EMR must build in the ability to track episodes of care.
- Examples using ICPC to do this exist here (UM, Lee Green) and in Europe
- HealthXML must include this ability
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15
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- The EMR must be incredibly easy to use, with excellent online support
and both self-directed training the opportunity for individual and group
instruction.
- There must be a way to easily enter data for multiple problems during a
visit, and to quickly add unanticipated problems to an encounter.
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16
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- Compliance with HIPAA standards is built into most EMRs
- Technology exists now, but requires good practices by physicians
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17
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- It should allow physicians to carry a subset of the data and
functinality in a PocketPC or Palm device, as a way to gather and access
data while out of the office. This could also be accomplished wirelessly
with a client-server model.
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18
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- Basic research to identify best interfaces
- Independent consumer research to compare products for ease of use and
total cost of ownership
- Ability to “opt-in” easily to be part of an electronic research network
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19
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Notes
