Implementing electronic health records in physician offices: lessons learned.

recent survey by the National Ambulatory Medical Care Survey (NAMCS) found that a quarter of office-based physicians reported using an electronic health record (EHR) in 2005. 1 While this is a 31% increase from its 2001 survey results, it is a far cry from the rate of adoption that experts think is needed for optimal information access and documentation. With the national push to adopt electronic health records (EHRs) and benefits such as increased efficiency, patient safety, security, and quality of care, adoption rates are sure to increase in the coming years. MetaStar, the Wisconsin Quality Improvement Organization, is currently working with approximately 50 physician offices in Wisconsin to help them adopt EHRs and other health information technology (HIT) through the Doctor's Office Quality-Information Technology (DOQ-IT) initiative. DOQ-IT is a national initiative that is supported by the Centers for Medicare & Medicaid Services (CMS), the American Medical Association, the American Academy of Family Physicians, the American College of Physicians, and Bridges to Excellence, a multi-state, multi-employer coalition. DOQ-IT was created by CMS to assist small-to medium-sized physician offices to implement and use EHRs. The free consultation is being provided to primary care physician offices, and is being deployed by the Medicare quality improvement organizations for each state. Besides assisting in adoption of EHRs, DOQ-IT also assists offices in electronically submitting clinical measure data for the Physician Quality Reporting Initiative (PQRI). Each state is allowed to create its own process to assist its physician offices. MetaStar offers a 4-stage roadmap for EHR adoption that was created with national consultants and a statewide advisory committee. The stages are planning, selecting, implementing, and improving with an EHR. While working with practices to move through these stages, MetaStar has observed what facilitates a small physician office in implementing an EHR and what barriers still exist. The objective of this article is to share these lessons learned in the hope that other practices will be helped by them as they move toward EHR and HIT adoption. Wisconsin's health care system is primarily composed of integrated health care systems and large group practices. Many of these systems have already implemented EHR systems, and many others have begun the implementation process. Not only have such systems paved the way for smaller practices to begin exploring EHR implementation , but larger systems now are able to offer their EHR systems to independent practices at a fraction of software …