EASE OF USE Continued EHR training can help staff members who may be reluctant or fearful to embrace change.

Electronic health records. To some, these 3 words are music to the ears. To others, they make the blood run cold. There's no denying that transitioning to EHRs comes with its share of challenges. But in many ways EHRs represent a significant upgrade from the pen-and-paper era — and they're only going to get better as users learn how to unlock their potential. Here are 8 of the most common anxieties people have about the transition to EHRs, along with some prescriptions for overcoming the real-life hurdles.

"It costs too much." An EHR system requires a significant investment of financial capital, not including the expense of the time required to use it effectively. One study (osmag.net/MZe7Bd) puts the implementation cost for a 5-physician practice at $162,000, with $85,500 in first-year maintenance expenses. Until recently, it was difficult to determine ROI surrounding the adoption of EHRs, but the technology is beginning to have a measurable impact on reimbursements. EHR systems can facilitate more accurate patient information, which can affect claim accuracy and, in turn, collection rate. Also, the Medicare and Medicaid EHR Incentive Programs can help to cushion the blow. Individual providers "who adopt, implement, upgrade or demonstrate meaningful use" of certified EHR technology may receive $44,000 to $63,750, while hospitals may be eligible to receive more than $2 million.

"It will detract from our ability to focus on the patient." During the transition period, it's common for users to be more focused on following the new steps required to fill out or retrieve information from a patient record, as opposed to truly engaging the patient. Early on you may be preoccupied with the screen in front of you, but the process tends to become second nature over time.

"It will expose us to hackers and other threats to patient privacy." We've all seen the stories about hackers targeting healthcare organizations and holding them ransom. Some providers have restricted any remote access to lessen the threat, but my sense is that most organizations are so dispersed that they don't have that luxury. The other issue concerns the potential for in-house HIPAA violations. It's easy to photocopy or steal a patient's paper record. With EHRs, most systems have levels of security that let you track anyone who has accessed a particular record, so there are built-in protections. Put another way, I would argue that EHRs would decrease privacy issues.

"It will take too much time to use it effectively." Third-party educators and in-house "super users" can help to educate nurses, residents, surgeons and anyone else who will be using the system. Most EHR systems aren't designed with the proceduralist in mind, so surgeons tend to know just enough about the system to get them through the workday. An educator or super user can show you how to optimize the system for individual users — or at least a particular specialty — to take advantage of all the tools pertinent to that specific specialty.

This is a case in which it's probably best not to have been an early adopter, because the architectures of some EHR systems were built years ago, using archaic computer languages. The vendors who made them can provide updates to make the systems more robust and even more intuitive.

"It will degrade the quality of our documentation." An electronic patient record can occupy a lot of space, and some of the information it may ask for may be irrelevant or relatively unimportant to the surgeon. While that in and of itself is not a huge issue, there are some critical pieces of information that can be difficult to access. In most cases, this is an easy fix. Take a progress note, also known as the SOAP note, which is short for subjective, objective, assessment and plan. The subjective and objective could literally be 7 computer screens long, so the simple act of reconfiguring the SOAP note to an APSO note, so the assessment and plan are at the front of the EHR, would save a lot of time. The subjective and objective are still there for those who need them, but accessing the meat of the record — the assessment and plan — becomes more straightforward for the MDs.

"It will be too difficult of an adjustment for our technology-averse staff and docs." Physicians of my era — I'm 55 — may not be as facile with computers, or technology in general, as junior faculty or doctors just coming out of residency. In fact, some older physicians have such a fear of doing things "a new way" that when word comes that their facilities will be moving to EHRs, they accelerate their retirement dates.

The fact is that the technology has come a long way, and with proper and continued training, most people get over their fear of technology quickly. But there are workarounds for those who are too reluctant to change. Let's say I'm an incredibly busy surgeon who sees so many patients that I just don't have the time to mess around with EHRs. I'll have someone by my side — a scribe — to enter everything for me. There's also voice-recognition software capable of integrating with EHRs that has become quite popular since its early iterations.

"What if the power goes out?" Every facility needs to have a backup plan, with ancillary server farms as a first or second backup. When the unexpected does happen, seasoned staff and physicians should be able to adapt. But the younger physicians have spent their careers clicking through screens rather than working from paper charts, so when the screen isn't there, they might feel a little lost. Even so, power outages and other disruptions are a rare occurrence, and certainly no reason not to invest in an EHR system. The truth is that most of these systems have an uptime of 99%, so if downtime is 1%, you're talking about 3 to 4 days a year.

"It's not standardized." In computerese, we're talking about interoperability — essentially, being able to share patients' health information in a secure, efficient fashion. The U.S. Department of Health and Human Services wants EHR systems to be fully interoperable by 2024, meaning practitioners will be able to seamlessly share EHRs. We're not there yet, because disparate systems can't yet "talk" to each other, but we're seeing some positive signs. Look at what the Indiana Health Information Exchange (ihie.org) has done. Healthcare data is available to thousands of participating providers throughout the state. That's the future. That's the holy grail.

Here to stay
My advice to facilities that haven't made the transition, or even to those who have begun the transition but are struggling with optimization: Have patience and an open mind, because this is one instance in which "the new way" may actually be "the better way." OSM