Publications & Resources

What Is Holding EHR Back?

Why are medical practitioners, including those in health centers, reluctant to adopt HIT, specifically electronic health records (EHR) systems, in their practices? With the prevalence and popularity of Blackberrys, PDAs, laptops, GPS, and any number of social networking sites, it can’t be that they are shy about using technology.

Two recent white papers, made available by HealthPort and NextGen—leading providers of  technology solutions for the health care community— shed some light on why EHR (also called EMR) systems are not completely utilized, but also provide advice for the successful adoption and implementation of EHRs.

A survey report by the National Association of Community Health Centers (A National Survey of Health Information Technology (HIT) Adoption in Federally Qualified Health Centers, NACHC, May 2009) cites barriers to implementation, including limited resources to invest and sustain EHR operations; inability to integrate with existing practice management systems; concern about loss of productivity during implementation; lack of support from physicians; and lack of project management staff” as barriers to implementation. (However, with dollars now flowing from the American Recovery and Reinvestment Act (AARA) for HIT implementation, the barrier of limited resources for investment and up-front costs is now being largely removed.)

In the HealthPort paper, EMR Success—What Makes a Truly Successful EMR Implementation?, Mark Anderson, CEO of AC Group, a health care technology advisory and research firm, confirms the NACHC findings and says, “The main concern we hear is that EMRs slow physicians down.”

Nancy Team, Director for Community and Indian Health Centers for NextGen, agrees with Anderson and says that most health centers believe they “can’t afford to slow up and learn a new way of doing things.” Team points out that “a demonstration is not a real world exposure” and asserts that those who are the most resistant are those who haven’t been exposed to electronic records management (EHR) systems.

“There are definitely huge benefits to EHR,” says Team. “Especially for the patients that health centers see.”  She points out that conditions such as diabetes, hypertension and depression can be monitored much more effectively via an EHR system, which puts lab values, blood pressure levels and other details of a patient’s history at doctors’ fingertips. Team adds that “to provide a total health care home—to provide a comprehensive plan of proper care with a paper chart is
almost impossible.”

According to Team, with ARRA stimulus money offering “a once-in-alifetime chance to get an HIT that works for them,” health centers should make finding and implementing the right EHR system a priority. To do so, Team suggests that health centers –

  • Look for a system that is CCHIT certified annually.
  • Look for vendors that have health center experience and can offer a fully integrated system that incorporates information about dental, vision and behavioral health as well as medical.
  • Look for a product that is easy to use.
  • Look for a company that has strong customer support, and avoid outsourced customer support.
  • Look at the products that are being used the most and visit the clinical settings where these products are actually in use.
  • Ask colleagues at other health centers who are already using an HIT what works best and what they would change. “There’s nothing better than a peer-to-peer conversation,” says Team.


The NextGen paper, Strategic Secrets of Successful Health Center Controlled Networks (HCCNs): How Healthcare IT Enables Growth and Increases Care Quality, addresses concerns about lack
of funds to purchase an EHR system and examines shared services and functions for health centers, particularly those in rural or underserved urban areas. “Centers can really benefit from an IT collaboration,” says Keith Williams, president of the National Cooperative of Health Networks (NCHN), an association designed to support health care alliances through networking, leadership development and education.  William says, “Just about every service or function that health centers provide can be shared. If one health center can achieve something with a certain amount of money, it’s logical that multiple centers can realize at least the same or better results by sharing the service.”

Recently, the Health Resources and Services Administration (HRSA) issued grants for over 1,400 health center-HIT projects totaling nearly $456 million. The agency expects to soon announce the availability of $125 million in grants from the ARRA for Health Center Controlled Networks (HCCNs). As stimulus funds provide incentives, HCCNs may be a more reasonable approach for smaller health centers to access support and utilize systems.

Both white papers emphasize that when preparing to research the purchase of a system, health centers should have a “strong internal committee” to facilitate the purchase and manage implementation. A team approach to selecting a vendor and software, careful planning, realistic  expectations and sufficient training are essential elements to successful electronic medical records (EMR) implementation.

For further information on the papers and reports mentioned in this article, visit the following websites:

NextGen at;
HealthPort at; and



Seven Questions to Guide EHR Selection and Purchase

Many Health Centers and HCCNs simply don’t know where to start when adopting EHR technology.  Experts offer the following seven questions to help select a reputable and responsive vendor:

  1. Is the technology certified by the Certification Commission for Healthcare Information Technology (CCHIT)? Does it maintain its certification from year to year?
  2. Is the system built on a common platform—like Microsoft—that is compatible with existing technology, and is easy to support and use?
  3. Can the vendor offer an enterprise-wide, integrated platform to facilitate seamless operation with practice management systems, dental software and more?
  4. Does the system store information as discreet data elements, so it can be mined and extracted to create customized reports and meet unique information requirements?
  5. Does the system exhibit open architecture that will interface with other “best of class” technology?
  6. Is the vendor able to demonstrate financial stability and a commitment to continue developing the next generation of technology to meet future needs?
  7. Are you confident that the vendor will provide superior service during planning, training,  implementation, and beyond? How do current clients rate the vendor’s customer service?

©Copyright NextGen 2009 from the white paper, Strategic Secrets of Successful Health Center Controlled Networks (HCCNs): How Healthcare IT Enables Growth and Increases Care Quality.

Related Documents:

10-21-2009 Printable - What Is Holding EHR Back? (175kb)

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