Success of Electronic Medical Records Varies With Cardiology Practice Size


WASHINGTON — The introduction of a customized electronic medical record system in a multisite practice of heart specialists enhanced efficiency and the quality of care that the patients received, said Dr. Vince Bufalino in a presentation at the Heart IT Summit.

Dr. Bufalino, who came to the summit from the 55-physician multisite Midwest Heart Specialists practice in suburban Chicago, reported on a host of improved outcomes that the practice has documented since it developed an electronic medical record (EMR) system in 1997.

He detailed improvements in the numbers of patients achieving LDL-cholesterol goals, significant increases in the numbers of coronary artery disease and heart failure patients taking recommended drugs, and more. He also said his practice's customized EMR system “has made us more efficient” and “it practices the way we practice.”

The summit, which was sponsored by the American Heart Association, American Stroke Association, the Agency for Healthcare Research and Quality in coordination with the Office of the National Coordinator for Health Information Technology, was devised to “develop a road map” for using IT to improve the quality of care for patients with cardiovascular disease and stroke. Each organization went home with a list of potential strategies developed by break-out groups focusing on clinical practice, research, and patients.

However, Robert Miller, Ph.D., who reported on electronic happenings in solo and small group practices, said that of 14 primary care practices he and his associates studied, only 2 had extensively used their electronic medical record systems to improve chronic and preventive care.

Dr. Miller, of the University of California at San Francisco, said that practice support services and performance incentives that are tied to quality improvement are “musts” for increasing the “value for all” of EMRs in smaller practices.

Overall, the physicians in his study saw a mean revenue gain from EMRs of $33,000 per full-time provider per year after an average “pay-back time” of 2.5 years. Almost all of that gain came from increased coding levels and efficiency-related gains—results that are a good value for many practices but not for payers or even patients, he said.

The differences between the large IT leaders and the small- to medium-sized practices that are attempting to build electronic systems—or still rejecting them—were the cruxes of the summit.

“We all know the quality benefits of the EMR” from the larger practices, “but how do we actually roll it out on a larger scale?” said Dr. Rose Marie Robertson, chief science officer of the American Heart Association.

The problem is that little is known about how off-the-shelf systems work in everyday practice and about what nontechnical factors—such as organizational factors—are needed to sustain electronic systems, she and other physicians at the meeting said.

The physicians recommended developing interoperable systems, standardized clinical no-menclature and decision support tools, fiscal and nonfiscal incentives for using EMRs, and sharing best practices.

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