Dermatologists have been slow to adopt electronic health record technology, in large part because few of the products available meet their needs, experts who have studied and implemented the technology report.
It is likely that incentives provided by the Centers for Medicare and Medicaid Services (CMS) to encourage widespread implementation of EHR technology will lure some additional dermatologists into the EHR marketplace, but the systems remain expensive and may not be worth the costs for some, said Dr. Joseph S. Eastern, a dermatologist in private practice in Belleville, N.J.
Photo courtesy Patricia Heiden
Dr. Mark D. Kaufmann
To be eligible for the incentive payments, which can total up to $44,000 over 5 years under Medicare or up to $63,750 over 6 years under Medicaid, physicians will need to implement EHRs and then achieve what CMS calls "meaningful use" of those records, which will mean reporting numerous quality measures to CMS beginning in 2012.
A survey released in this month suggested EHR adoption among physicians is set to soar in response to the promise of the incentive payments: some 41% of office-based physicians polled by the National Center for Health Statistics said they are planning to achieve "meaningful use" of EHR technology in time to take advantage of the payments.
Still, Dr. Eastern said, "my hunch is the actual figure will be lower when push comes to shove, and lower still for dermatologists, because the incentives don't begin to compensate for the problems inherent in making the switch from paper to electronic records."
Dr. Mark D. Kaufmann, of the dermatology department at Mount Sinai School of Medicine in New York, agreed. "Many will be enticed to adopt now, but when confronted by the actual cost of adoption, they may become more hesitant," he said in an interview.
Also, despite claims that EHRs will improve quality, it’s not clear whether that will be the case for dermatologists. Dr. Kaufmann said the systems can set up clinical decision support that can help to remind physicians to check certain labs and keep track of melanoma patients.
However, Dr. Eastern was more pessimistic about EHRs' prospects for improving quality. "I frankly don’t think they can [improve quality], other than some limited coordination of care with other specialists, and elimination of some treatment redundancy and prescription errors. The government says it wants to improve quality, but what it really wants to do is collect data on physicians; that’s the primary reason for incentivizing EHRs," he said.
The technology may help improve office efficiency, but it may also "amplify errors," Dr. Eastern said. "Attempting to automate a chaotic system of paper records will only increase the chaos. If your paper records are poorly organized, solve that problem before even considering a switch to electronic records. Well-structured paper records predict well-structured EHRs."
There’s no question that adopting EHRs will be expensive for dermatologists.
Stand-alone EHR systems can cost anywhere from $50,000 to $100,000, Dr. Kaufmann said, and may be more practical for larger dermatology practices.
Small solo practices tend to purchase Application Service Provider (ASP) or Software as a Service (SaaS) systems, which don’t involve hardware installation and require only Internet service, Dr. Kaufmann said. ASP and SaaS start around $500 a month, he said.
Few systems meet the needs for dermatologists out of the box, according to both practice management experts.
Some vendors offer templates – blank forms customized to the practice of dermatology that can be filled in easily when seeing the patient – as part of the EHR system to make it more "dermatologist friendly," Dr. Kaufmann said. However, nearly every dermatologist winds up having to design his or her own templates to meet specific needs, he said.
Dr. Eastern added that dermatologists should avoid any system designed for other specialties, regardless of any claims the vendor might make about how easily it can be adapted for dermatology. In addition, he warned that dermatologists should avoid using a hospital’s "free" EHR, since the physician often has to purchase hardware and service contracts. Many so-called free EHRs come with strings attached, he said.
Dermatologists considering implementing their own EHR systems should visit colleagues using similar systems to see how they're working, said Dr. Kaufmann. Vendors often will provide names of physicians who have implemented their systems, and EHR seminars at professional meetings also can provide some leads.
It's often not an easy process, he said. "The learning curve is steep, ongoing costs may be steep, and the incentive money may wind up being a 'Trojan Horse.'?"