Adopting EMR system depends on what works best for each practice

Early adopters, "techno-geeks," and large academic or multispecialty practices are likely to have electronic medical records (EMR) systems already. But for the rest of the ophthalmology community, is it time to consider this investment, or still premature?

While the answer comes down to what's best for each practice, overall there is some degree of consensus that there is no need to rush into a complex and costly decision regarding EMR.

"You should buy it if it makes sense for your practice, period," said Ron Rosenberg, MPH, PA-C, president of Practice Management Resource Group, Sausalito, CA. "If there's something in it for you, either quality or cost or efficiency, you should look into it. There will be a subset of physicians who are techno-geeks who may buy it, but they should not fool themselves or rationalize that they need it. They should look dispassionately at what they're getting for their money and whether it will work for them."

Federal initiatives

In 2004, President Bush issued an executive order calling for development and nationwide implementation of an interoperable health information technology infrastructure within the next decade. Bipartisan measures pertaining to that goal, such as incentives for small and medium size practices to invest in EMR, have made it through Congressional committees but not yet into law, according to Nancey K. McCann, director of government relations for the American Society of Cataract and Refractive Surgery (ASCRS).

Despite this interest in EMR on the part of the executive and legislative branches, McCann also advises a cautious approach.

"Until standards are developed I don't think it's wise to invest in an EMR system because if you do, it's going to have to be changed and updated and you're going to have to spend more money doing it," she said. "For the small practices, it's expensive and onerous to make that kind of investment."

The Office of the National Coordinator for Health Information Technology is developing standards. Since the standards will define what information must be included in an electronic health record and what information needs to be captured, a system available today might not meet the requirements that may eventually emerge from this process, McCann explained.

Interoperability will also be a significant issue in the standards and the future of EMR, but it is difficult to achieve with today's systems. Interoperability refers to the ability of EMR systems throughout the health-care system, including Medicare, to communicate with each other. McCann and others suggested that physicians in small or medium-sized practices who want to move ahead with EMR soon should concentrate more on what a system could do within their practices than on becoming part of larger networks.

P4P and SGR

EMR is also tied in with the issue of pay for performance (P4P), since an electronic records system ultimately will be necessary to participate in P4P. Initially, the government will use claims data for P4P, but ultimately the information will be derived from EMR, McCann said. However, P4P is a work in progress, with various specialties in different stages of preparing guidelines. Ophthalmology is just beginning to develop the measures that physicians would need to report under a P4P system, and it might be advisable to postpone a decision on EMR until more information is available.