TEPR Tantrums

Gary Baldwin, for HealthLeaders News , May 25, 2007

The presentation was called "Getting Physician Buy-in." But TEPR Conference participant Tushar Shah, MD, a partner in a three-physician pediatric practice, wasn't buying. Shah went to last week's event in Dallas in search of an electronic medical record system for his small group, which is based in Abilene. He was one of one some 200-plus people who jammed into the session, which targeted small physician practices. So many participants crowded the presentation that event organizers halted it abruptly in mid-stream to move to a larger room.

They heard Paul Schadler, MD, describe how his 11-physician practice struggled through its EMR journey, which began five years ago. Unlike some EMR advocates, who are basically preaching to the IT choir, Schadler gave a warts-and-all account of his group's experience. The EMR, he said, is a "dramatic work change" for physicians, one that creates "more work." According to Schadler, much of the work in the paper-based practice shifts directly to the physician in the electronic world. "They billed, now you bill," he said.

Despite his apparent skepticism about the merits of an office practice EMR, Schadler went to lengths to explain that in the long run, automation is worth it. Along the way, he dispelled some common EMR notions, such as the value of capturing discrete data, which can subsequently be searched and analyzed. Schadler labeled it a "fantasy" that somehow the reams of data in a physician practice would ever be monitored.

For Shah, however, the short-term fantasy is buying an EMR. He praised the presentation, but wondered aloud how his practice could ever afford the software. Later, Shah and I caught up on the exhibit hall floor. Nowhere near as big as the HIMSS show, TEPR lends itself to such impromptu networking. Like the majority of small physician practices, Shah's group uses a computerized practice management system for billing and scheduling.

It's been in place for years. He's not too keen about yanking it out to buy a one of the new "hybrid" practice management/clinical documentation systems on the market. But there's more to it than that. A pediatric practice can't afford to shell out the money for software whose financial benefit would be dubious at best. Shah has scoured the market, and figures that an EMR package would easily be a six-figure investment.

His is a common dilemma. Physician offices would love to automate, but they perceive that the financial benefits accrue to others. During the question-and-answer portion of Schadler's talk, Shah volunteered a solution. If a physician implements an EMR, then they should be paid for the initial encounters as new patient visits, which reimburse at a higher level. Even though the patient in reality may be an established one, in essence a newly automated practice would have to act as if they were being treated for the first time.

If any payers were in the audience, they didn't respond to Shah's idea. The exchange distilled one of the biggest issues facing the industry, however. A subsequent presentation, by Ric Smith, director of operations at New York Heart Center, revealed that physicians taking the EMR plunge can benefit financially. In Smith's case, the center has seen referrals go up 18 percent, primarily because the electronic documentation system makes it easier to dispatch records to the requesting physicians. And Schadler pointed out that physician productivity can improve once the practice adjusts to the new workflows.

One thing's for sure. The decisions made by physicians like Shah in the years ahead will have enormous impact on the industry's ability to expand the IT choir. Is the industry listening?

Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at gbaldwin@healthleadersmedia.com.

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