Potential Effects of the EHR on the Small-Physician Practice: A Delphi Study
This study examined the possible effects of the EHR on the small physician practice. The design for this study was based on the incomplete nature of the EHR. The modified Delphi design was selected for this study due to its ability to avoid the ambiguity often seen in the classical model.9 Quantitative methods cannot fully ascertain the financial or patient outcomes until, and unless, the government fully implements Meaningful Use Stage 3. Until this occurs, quantitative studies can only show the effect of the current stage, not the complete product. Once a final stage 3 fully-certified EHR system is in place, quantitative studies would be appropriate.
The HITECH Act established the requirement of all medical practices to have certified EHRs. Some primary concerns, which have been delaying implementation, are issues of cost, revenue impact, and the effect on the patient encounter. Small physician practices (1-4 physicians) represent 46 percent of all medical physicians. The purpose of this qualitative method study using a modified Delphi research design was to examine the potential effect 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. Expert panelists reached consensus that the EHR would reduce the number of patients seen per day, thereby reducing their revenue. 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 cause physicians to miss medical conditions. The results of this study indicate an avenue 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.
Keywords: small physician practice, electronic health record, HITECH Act, Meaningful Use
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