Financial and Patient Impact of Electronic Health Records on Small Physician Practice: A Delphi Study

Financial and Patient Impact of Electronic Health Records on Small Physician Practice: A Delphi Study

Author: 
Chad Christopher Sines
Program of study: 
D.B.A.
Abstract: 
The HITECH Act established the necessity of all physicians and facilities to have established EHRs. The primary concerns are issues of costs, revenues, and the effect on the patient encounter that inhibit the implementation of the EHR in small physician practices which comprise 46% of all medical physicians. The purpose of this qualitative method study using a modified Delphi research design was to examine the impact of the adoption of an electronic health record (EHR) on revenue, unintended costs or savings, and changes in the patient encounter. Fifteen expert panelists completed the three round survey process used in this Delphi study. Expert panelists reached consensus that the EHR would reduce the number of patients seen per day, thereby reducing their revenue. Small practice closure was a concern for the panelists who felt not enough was known about future cost increases and reductions to fully understand how viable small practices would remain. Although the expert panelists limited their discussion on the effect of patient outcomes, they voiced their most dominant concern being a loss of face-to-face time with the patient. It was felt that the use of an EHR would reduce the focus on the patient and potentially allow physicians to miss medical conditions. The results of this study indicate an opportunity for EHR vendors to develop educational avenues to teach physicians how to optimize the EHR as well as to share success stories that demonstrate improved financial impact.
Dedication: 
I would like to dedicate this to my family. You have each helped me immensely along this journey. To my daughter, Shari Lynn. You meant and still mean the world to me. You were only with us for 10 years, but you shaped my life and left an impression on those who knew you that will never be forgotten. The world is a much sadder place without you. To my mom and dad, thank you for all that you have sacrificed for your kids that gave us these opportunities. You have always been there, and that has meant everything. To my sisters Shannon and Melissa, I’m the favorite.
Acknowledgements: 
I am grateful to my committee members Drs. Suzanne Richins and Phillip Davidson for their feedback and expertise along the way. I am especially grateful to my committee chair Dr. Gerald Griffin for his guidance along this journey. You did not spoon feed each step in the process but challenged me to think for myself. This was greatly appreciated. I am grateful for my expert panelists whose efforts made this research possible. Your input was insightful and helped add to the collection of knowledge. I am also grateful to Erick Adams, future doctor himself. Our tragedies in common led to our first conversations, and a great friendship developed. You have been a continual source of support and friendship that will last a lifetime. For those I have not mentioned, friends, family, and colleagues, I appreciate your support and guidance throughout this process.