News Feature | October 3, 2013

Will EHRs Benefit Small Practices?

Source: Health IT Outcomes

According to a new survey small practices can benefit from having an EHR system in place but support limitations will hinder the process

A study posted on the Journal of the American Medical Association website set out to “assess the effect of pay-for-performance (P4P) incentives on quality in EHR-enabled small practices in the context of an established quality improvement initiative.” The authors felt this was important because, “Most evaluations of P4P incentives have focused on large-group practices. Thus, the effect of P4P in small practices, where many US residents receive care, is largely unknown.”

The study found, “Among small EHR-enabled clinics, a P4P incentive program compared with usual care resulted in modest improvements in cardiovascular care processes and outcomes. Because most proposed P4P programs are intended to remain in place more than a year, further research is needed to determine whether this effect increases or decreases over time.”

According to Information Week Healthcare, JAMA’s report, “suggests that when practices with fewer than 10 clinicians are equipped with an electronic medical record system -- one that also includes clinical decision support capabilities and registry functionality -- they, too, see improvements in several quality metrics. The report shows modest improvement in the rate of appropriate anti-clotting drug prescriptions, for instance, as well as better blood pressure control, diabetes care, and increased smoking cessation interventions.”

They do point out, however, that the practices in the study received assistance including “coaching clinicians on EHR quality improvement features, supporting workflow redesign, and demonstrating proper EHR documentation of the study measures," according to Naomi Bardach, MD, from the University of California in San Francisco, and associates. In reality, small practices would never be able to afford tech support like they were provided with in the study.

This notion of nonexistent or poor tech support was the focus of a recent Health Affairs article which found EHRs only improved patient care when the practice was under the watchful eye of tech support and had training in the EHR system. Andrew M. Ryan, lead investigator and a professor at the Weill Cornell Medical College in New York said, “Our study shows EHRs can in fact be a tool for quality improvement, but not in isolation. Technical assistance must be at the heart of the EHR implementation process."

And with 80 percent of doctors working in small practices hoping to implement an EHR system this year, there is a lot more demand that only increases the likelihood vendors will be more interested in selling rather than supporting, according to Information Week.