When MGMA examined the 20.7 percent of EHR users who said they had optimized their EHR since implementation, 41.1 percent reported productivity had increased, 16.5 percent indicated productivity had decreased, and 42.4 percent reported there was no change in productivity.

More than one in three (38.4 percent) of all EHR users said total practice operating costs increased following EHR implementation, while 25.9 percent said costs decreased and 35.7 percent reported no change in cost.

When MGMA examined only those who said that they have optimized their EHR since implementation, 26.8 percent said total practice operating costs had increased, while 39.7 percent said costs had decreased and 33.5 percent reported no change in costs.

Fear of productivity loss a barrier
Of practices still using paper records, more than 78 percent feared there would be a "significant" to "very significant" loss of provider productivity during implementation, and two-thirds (67.4 percent) had similar concerns about the loss of physician productivity after the EHR transition period.

The practices still using paper medical records described the other significant to very significant barriers to EHR adoption as “insufficient capital resources to invest in an EHR” (71.7 percent) and “insufficient expected return on investment” (56.9 percent).

"The EHR incentive program seeks to address implementation costs, a critical barrier to medical groups' adoption of EHRs,” said MGMA President and CEO William F. Jessee, MD. “While the majority of groups plan to have their eligible professionals participate in the program, including those organizations that have not yet implemented an EHR, it is clear that groups face significant system optimization challenges.”

Jessee said he hoped that future stages of the incentive program would take into account the difficulties medical groups face in meeting the meaningful use requirements.

Independent vs. hospital-based docs

Practice ownership influenced EHR implementation and optimization. Interestingly, independent medical practices were more likely to have a fully implemented and optimized EHR than their peers owned by hospital systems.
 
“Hospital-based practices have access to information resources of their parent health system, which would normally imply that these practices would be further along toward optimization,” said MGMA Innovation and Research Vice President David Gans, who directed the research.

“However, integrated systems are much more complex environments than independent physician practices and their information systems often have to encompass both in-patient and physician components,” Gans added.

He said the added complexity, combined with the geographic dispersion of most hospital-based physician practices, has hindered the advancement. In addition to redesigning how patient care is delivered, practices must redesign workflow, more fully utilize the system’s capabilities, integrate the EHR and practice management systems, and fully coordinate system interoperability with systems used by hospitals, reference laboratories, imaging facilities, pharmacies, insurers, etc., to realize the benefits of an EHR.  These activities are much more difficult to achieve in hospital systems.”

One of the hurdles in optimizing any new technology is adequately training new users. More than half – 53.2 percent of respondents – said they either "mildly" or "severely" under-allocated the training time needed during the implementation of their EHR systems.

Rosemarie Nelson, principal of MGMA Consulting Group, provides help with EMR purchase and installation for physician practices.

How difficult the EMR is to use can also be a deterrent to adoption and a hurdle to making the most of the technology, she said.

What is most often missing, in her view, is a commonsense approach to workflow – how the typical physician’s day flows as he or she interacts with patients and the practice’s support staff.

“The EMRs could be better at taking advantage of the well choreographed dance between doctor and clinical support staff to accomplish seeing patients in the office and attending to the aftercare communications (results, calls) associated with taking care of patients,” Nelson said.