Most single and small medical practices aren’t using EHRs to engage with patients, according to a survey of 19,000 practitioners.
The Black Book Research survey of practitioner satisfaction, conducted in the first quarter of 2018, found that only 8% of solo practices are frequently using patient engagement functionalities, such as patient portals, available from EHRs. Five percent of solo practices report using EHRs for electronic messaging, and 6% use them for clinical support. Only 13% of solo practices are using their EHRs for record sharing, or are interoperable with other healthcare organizations.
The survey found that although small to midsize practices with two to 14 practitioners are using EHR patient engagement functions more, there is still a gap between frequent use. Only about 30% of small to midsize practices are frequently using electronic messaging, clinical decision support, and interoperability functions of their EHRs.
Why smaller practices are struggling more
Solo and small practices face unique challenges that lead to them not fully utilizing EHR functionality, says John Fleming, MD, deputy assistant secretary for health technology reform for the Office of the National Coordinator for Health Information Technology.
“Small practices are the most efficient and require the least amount of subsidies to operate. But how do we deliver to small practices all of the technology capabilities as the large institutions at a cost-effective rate?” Fleming says.
He says that smaller practices often don’t have the budget to purchase upgraded services or pay for continuous maintenance of EHRs.
“A lot of small practices don’t have discretionary dollars to provide additional services that would be helpful to patients,” Fleming says. “They may require more money to purchase them and additional expertise to maintain them. If they aren’t a part of a huge health system, sometimes they have to make a choice.”
Many smaller practices may be in rural areas with little or no broadband internet access, therefore cloud-based services that often add to EHR functionality may be impeded, Fleming says.
What providers want in EHRs
The survey found that 93% of practitioners want access to cloud-based mobile solutions for on-demand data. Almost 90% desire access to telehealth and virtual support, and 82% want EHRs with speech recognition for hands-free data entry.
“Our goal is to individual and small practices affordable access to modern technology that eases their cognitive and time burdens so that they can get to what they do best, which is engage with patients,” Fleming says.
It is important for small practices to engage with EHR vendors that can meet their specific needs, Fleming says. He adds that small practices should also work to become interoperable with local hospitals as a way to leverage resources.
Although 93% of practitioners report being loyal to their EHR vendor, small practices have the highest EHR dissatisfaction rates, but also use less-advanced functionality tools, according to Black Book Research. As a former solo practitioner who had a solo practice, Fleming cautions practice owners against jumping to new EHRs when dissatisfied with functionality.
“I changed EHR systems twice, and it is not like switching from Apple to Windows,” Fleming says. “It’s a very expensive process.”
Most utilized EHR features
The most utilized EHR functions across all practices regardless of size are data repository, order entry, and results review, the survey found. Doug Brown, managing partner of Black Book Research, says that the smaller the practice, the less likely they are to use advanced IT tools and that is where EHR frustration among small practices is generally focused.
"When we look at apples-to-apples client satisfaction among small practices, it's about basic functionality experience,” says Brown. "While in large practices, the rating of customer satisfaction is based on that plus a much wider breadth of vendor offerings and client execution from claims management to population health bundled in."
Donna Marbury is a writer in Columbus, Ohio.