Wading into EMR: Going electronic, one step at a time

You don't have to put your practice through an extreme tech makeover. Experts offer some suggestions for testing the waters with incremental changes.

By Tyler Chin, AMNews staff. Nov. 13, 2006.

Four years ago, Partners in Internal Medicine considered buying an electronic medical records system. The eight-doctor practice was having trouble finding paper charts and had run out of storage space.

But its doctors weren't ready to adopt the technology, much less swallow the $250,000 they were told an EMR would cost. So the group opted for a document imaging system, not only to address the immediate problems, but also to position itself for an eventual EMR. It was a fraction of the price.

"We called it a phase-one approach to achieving some operational efficiency, and reducing some of our overhead and expenses by transitioning to an electronic health record in this manner," said Debra Roberts, administrator of the Ann Arbor, Mich., group practice. "What is even nicer was that I didn't have to change my doctors' behavior. The only adjustment my doctors had to make was that they had to get used to looking at the record on the computer versus having a paper chart, but they still take notes on what we call a physician check list and they still dictate."

Given that EMRs have a reputation for being costly and disruptive to work flow, many doctors are avoiding them. But clinical automation doesn't have to be all or nothing, observers say.

Doctors can take baby steps -- with document imaging, electronic prescribing, portable electronic drug references and clinical messaging systems -- and gradually work toward an EMR, observers say. These stand-alone systems are cheaper and easier to use, and they help both doctors and staff prepare for an EMR. In some cases, the components can be linked together and integrated with an EMR, consultants said.