Traditionally, eye-care professionals (ECPs) have been slow to embrace electronic health record (EHR) technology in their practices, even though they also can receive incentive payments from the federal government for adopting the technology and attesting to meaningful use.
One reason might be that certain technologies and interfaces needed for eye care are not well supported by the current batch of EHRs.
SK&A, a Cegedim company based in Irvine, CA, is a research firm that's been around for about 28 years. Its annual report on EHR adoption, titled "Physician Office Usage of Electronic Health Records Software," derives data from continuous polling of every medical practice in the entire health-care industry. The resulting data get pushed out to the public each June and December.
SK&A surveyed 10,514 medical offices representing about 26,700 ECPs. The most recent report listed the overall adoption rate for ECPs at 36.4%. That, according to Jack Schember, director of marketing at SK&A, is a "decent jump" from the 32% rate recorded during the prior reporting period.
"When we began the study the trend clearly showed that larger medical offices, and those owned by hospitals and health systems, were the earliest adopters," he said. "This made sense, because those offices had financial support and IT guidance from their corporate parents. Now we're seeing solo practices and smaller offices catching up."
But, why are ECPs still slow to adopt EHRs? What barriers hinder their use of EHRs in their practices? And what do EHR manufacturers need to incorporate into their designs to address the needs of ECPs?
"It's a big change, EHRs," said Flora Lum, MD, executive director of the H. Dunbar Hoskins Jr., MD Center for Quality Eye Care, the Foundation of the American Academy of Ophthalmology (AAO), and the policy director for Quality of Care and Knowledge Base Development for the AAO, San Francisco.
"It will change the workflow, and how patient data are entered and accessed," Dr. Lum continued. "So you really have to understand all the different pieces—preop, surgery, and postop, initial patient workup, getting patients into testing, and procedures—how does that work now, and how would EHRs [affect] that workflow?"
An EHR dramatically changes a practice's workflow and access to patient data. For a primary-care practice, that alteration can stifle productivity. In a specialty practice, like eye care, it can be a deal breaker if serious thought isn't first given to the best method for introducing the new technology.
"I think ophthalmologists are particularly innovative technology-wise," Dr. Lum said. "The EHR pioneers worked with systems 10 to 15 years ago. But even 5 years ago, the EHR systems weren't quite up there, and the interfaces weren't quite there.
"I think we're getting there now," she continued. "But those early investments tended to shade expectations and perceptions. The technology is getting better, cheaper, and broader in its availability. But we're obviously not there yet totally with broad adoption, wide acceptance, and easy use."
Past surveys showed adoption of EHRs among ECPs at about 13%, a small number compared with primary-care practices. It is the hope of the government, however, that its meaningful use program will accelerate those numbers and bring total adoption across the board to around 85% by 2015.
"I wouldn't be surprised if we're getting closer to 40% to 50% in 1 year or 2 with the meaningful use incentive," Dr. Lum said.
"They needed more time to evaluate their options, put together initial financing plans, and allow for the training of staff," said Schember, commenting on the recent increase in EHR adoption among specialists.
"The reimbursement provided for meaningful use was also a big incentive for adoption," he continued. "Given that offices with one or two physicians represent about 72% of all practice sites, I think this trend will continue but at a measured pace."