Is the use of digital management technology in health care finally catching up with the other industries? The new numbers are showing that more and more providers are adopting electronic health records (EHR).Interestingly enough, when looking at small private practices, doctors of chiropractic are matching or even slightly exceeding adoption by medical providers, and these numbers could increase exponentially in the next two to three years. Could our profession be leading an important game-changer in health care delivery? And what's on the table for us if we do?
An Undeniable Trend
An estimated four of every 10 large-scale practices have already adopted electronic health records, according to preliminary 2009 estimates from the CDC.1 I believe that within the next two years, close to half of both large-scale practices and hospitals will implement EHR. As we might expect, small physician practices (one to five physicians) are slower to adopt, but still offer a strong showing at 8-12 percent adoption for a true EHR. Approximately 20 percent reported using a "basic" system with EHR. Another study by the Texas Medical Association estimates that 43 percent of respondents used an EHR system in 2009. Physicians under the age of 40 had even higher adoption rates.
When comparing chiropractic to medical adoption in the small-practice category, doctors of chiropractic are matching or even leading the way. Care should be taken when comparing two different kinds of practices; nevertheless, chiropractors, most of whom are in a small-practice setting, have adopted as high as 19 percent, based on several surveys.2 I fully expect these numbers to rise not on a soft, gentle curve, but essentially like a hockey stick. According to numerous recent surveys, anywhere from 75 percent to 85 percent of chiropractors who have not yet adopted have decided that they will adopt sometime in the next six months to two years. Strong evidence suggests that much of this adoption will take place in the next two years, so by the time we get to 2013, a majority of chiropractors will be practicing using an EHR system.
Understanding EHR Adoption
The exponential movement toward complete digital management in health care can be easily understood if we examine the life cycle of the X-ray jacket; a symbol for the speed at which health care is moving. For the past four decades, exchanging records involved the X-ray jacket. For decades, signed patient requests for records were delivered via the postal service, to eventually be replaced by faxes. In either case, it would take days or weeks to finally have an old X-ray or MRI sent to your office. Sometimes it was simply faster if the patient picked up the imaging films themselves and hand-delivered them to you.
This past decade, CD-ROMs or DVDs came on the scene. Digital X-rays and MRIs began to arrive, often with the software to view the images stored on the disc itself. We could manipulate, zoom in and move the images around on our screen. A few clicks of the button and a radiology report could be read and printed. As many of us had no means to store the images digitally with the patient file, we would put our copy of the disc into, ironically, an X-ray jacket or the patient chart.
Within five years, both CD-ROMs and X-ray jackets will be gone entirely. By the middle of this decade, most imaging and test results will come from a direct electronic means, making the postal service and bulky storage devices unnecessary. It may be an encrypted e-mail or through a direct link to a health information exchange (HIE), hospital or imaging center's Web site. Whether by an account with provider "permissions" or EHR, we are going to have a nearly instantaneous exchange of health care information and completely digital storage. EHR is going to rule health care information and delivery of data.
Digital Management: Catching Up to Other Industries
As revolutionary as these accessible records sound, there is another perspective to consider: Health care is finally doing its due diligence and catching up with other large-scale industries. The trucking/transportation and manufacturing industries across the U.S. converted to digital management years ago. We need to realize that the same speed and efficiency that we want to offer in health care has been achieved in other areas of the economy for over a decade. For the first time, we are finally able to apply these kinds of mechanisms to how we deliver care. As amazing as it seems now, within a few short years, this speed of health care is going to become the norm, as it has in other industries. Those who are not participating may risk appearing substandard, while those who are technologically advanced will gain an edge.
What edge does an electronically connected chiropractic profession potentially gain? As stated above, we are facing a real opportunity to lead in the small-provider group. A few issues ago, I outlined in some detail my vision for what this chiropractic leadership might mean for us. I discussed how universal adoption of EHR, sharing electronically generated practice data, and systematically mining that data for information on patient outcomes under our care could be a game-changing opportunity. With these three achievements, we will show that our profession is modern, collaborative and willing to prove our outcomes with clinical data. As these latest numbers show, chiropractors are committed to the power of EHR. The first step is universal adoption. Within five years, we will be mostly there.
Factors Affecting EHR Adoption
Of course, what drives individual doctors to adopt EHR are the ways they benefit their personal practice. The primary concern of nearly all chiropractors can be summed in three words: ease of use. Your colleagues want a system that is easy to learn, implement and customize, and will not need to be replaced in a few years. After concern about ease of use, most doctors want to be able to create a 100-percent compliant patient note with appropriate speed that helps document necessity of care. After ease of use and compliance, most doctors would like complete integration of their electronic records with their billing and scheduling system, and HIPAA compliance with data backup and security to make the whole system efficient and secure.2 The top three reasons for DCs slowing their adoption rate are cost of software; cost of hardware and IT costs; and implementation unknowns of how to get started.
In my experience, staff is the number-one hurdle when implementing modern technology in the clinic. Change itself and switching to something new causes most staff to find reasons not to adopt new software. It is critically important to explain to your staff that this adoption of EHR technology is not simply a new billing system, but a complete automation of the practice with a digital system integrating the entire clinic data.
- Hsiao C-J, et al. Electronic Medical Record/Electronic Health Record Use by Office-based Physicians: United States, 2008 and Preliminary 2009. Centers for Disease Control and Prevention.
- Surveys on EHR adoption conducted by Future Health, Inc. Contact the author for additional information.
Click here for previous articles by Steven Kraus, DC, DIBCN, CCSP, FASA, FICC.