HCA 310 Module 1 Why EHRs Matter and How Practices Adopt Them Example

Leaving Paper Behind: Why Electronic Health Records Matter and How One Practice Can Adopt Them

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Health Care Administration Program, Aspen University

HCA 310: HIPAA and Electronic Health Records

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Leaving Paper Behind: Why Electronic Health Records Matter and How One Practice Can Adopt Them

Most American practices now use electronic health records, but some small and specialty offices still rely heavily on paper, and many that adopted early are replacing systems that never fit their work. Understanding why electronic records matter, and how to adopt one well, remains essential for health care administrators. This paper summarizes the evidence on electronic records and sets out an adoption plan for a composite three-surgeon orthopedic practice that still keeps paper charts.

The Practice

The practice sees about 180 patients a week for injuries, joint pain and surgical follow-up. It uses a practice management system for scheduling and billing but keeps clinical notes, imaging reports and operative notes on paper. Charts are sometimes missing at visits, faxed reports pile up unfiled, and the surgeons dictate notes that return days later. Referring physicians complain about slow reports.

What the Evidence Shows

Evidence on electronic records is broadly favorable. A review of recent studies of health information technology found that 92% reached conclusions that were positive overall, with benefits emerging in smaller practices as well as large early adopters, though provider dissatisfaction remained a barrier (Buntin et al., 2011). A later meta-analysis of 47 studies linked electronic record use to better guideline adherence, fewer medication errors, with a risk ratio of 0.46, and fewer adverse drug events, with no clear effect on mortality (Campanella et al., 2016).

Why Adoption Surged

For years, cost and disruption held adoption back. Federal incentive payments under the HITECH Act of 2009 changed the calculation, and national data show that hospitals eligible for those payments sped up their adoption far more than hospitals that were not eligible (Adler-Milstein & Jha, 2017). Physician offices followed a similar path. Today, electronic records are also expected by payers, referring providers and patients who want portal access.

Benefits for This Practice

For the orthopedic practice, an electronic record would make every chart available at once, place imaging and operative reports in one place, allow templated notes for common visits such as knee injections, send prescriptions electronically and give referring physicians faster reports. It would also support the patient portal patients have been requesting.

The Adoption Phases

Adoption proceeds in phases. The table summarizes them.

Readiness and Selection

The office manager maps current workflows, from check-in to billing, to see where the record must fit. She inventories computers and network capacity. The practice lists requirements, including orthopedic templates, imaging integration, a patient portal and connection to the existing practice management system, then compares at least three vendors using scripted demonstrations of real tasks and calls to other orthopedic practices using each product.

Data Migration

Paper charts cannot all be scanned before go-live. The practice will abstract key data, such as problem lists, medications, allergies and surgical history, into the new record for patients scheduled in the first three months, and scan older charts on demand. Charts of patients not seen in several years will remain on paper in secure storage until their retention periods end.

Training and Go-Live

Training is role-based: front desk staff learn registration and scheduling screens, medical assistants learn intake and orders, surgeons learn templates and electronic prescribing. Each person practices with test patients before go-live. For the first two weeks, schedules are reduced by a third and vendor trainers are on site.

Budget Items

Costs include software licenses or subscriptions, hardware, interfaces to imaging and the practice management system, data migration, training time and lost productivity during go-live. The office manager builds a budget with a contingency reserve and estimates savings from reduced transcription, fewer lost charts and faster billing.

Risks

Risks include staff resistance, templates that produce bloated notes, interface failures and a productivity dip that lasts longer than planned. The practice reduces these by involving a surgeon champion and a medical assistant champion in every decision, testing interfaces before go-live and setting realistic expectations.

Privacy and Security From the Start

An electronic record changes how privacy and security are protected. Role-based access, audit logs, encryption, backups and a downtime plan must be designed before go-live, not added later. The practice will complete a security risk analysis as part of planning.

Measuring Success

The practice will track time from visit to signed note, referral report turnaround, missing-chart incidents, prescription errors caught, patient portal enrollment and staff satisfaction at three, six and twelve months after go-live, comparing each with baseline measures taken before the switch.

Choosing Between Cloud and On-Site Systems

The practice must decide whether to host the record on its own server or use a vendor's cloud service. An on-site server gives direct control but requires the practice to handle backups, updates and security. A cloud service shifts those tasks to the vendor, usually for a monthly fee, but depends on reliable internet and a strong contract covering data ownership, uptime and what happens if the practice changes vendors. For a small practice without IT staff, a cloud system is often the more practical choice.

Connecting to Others

An electronic record is most valuable when it connects to others. The practice plans to join the regional health information exchange so it can receive hospital discharge summaries and emergency visit notices, and to send reports electronically to referring physicians. Interoperability standards allow records from different vendors to exchange key data, though connections still require setup and testing.

The Patient's View

Patients will notice the change. Check-in may take longer during the first weeks, and surgeons may look at screens more. The practice will tell patients in advance, place screens so patients can see them during visits and invite patients to join the portal, where they can read notes and results.

Conclusion

Electronic health records improve guideline adherence and reduce medication errors when well implemented, and federal incentives accelerated their spread. For a paper-based orthopedic practice, adoption means careful phases from readiness to optimization, thoughtful data migration, role-based training and attention to privacy from the start. Measuring results against a baseline will show whether the record delivers what the evidence promises.

References

Adler-Milstein, J., & Jha, A. K. (2017). HITECH Act drove large gains in hospital electronic health record adoption. Health Affairs, 36(8), 1416-1422. https://doi.org/10.1377/hlthaff.2016.1651

Buntin, M. B., Burke, M. F., Hoaglin, M. C., & Blumenthal, D. (2011). The benefits of health information technology: A review of the recent literature shows predominantly positive results. Health Affairs, 30(3), 464-471. https://doi.org/10.1377/hlthaff.2011.0178

Campanella, P., Lovato, E., Marone, C., Fallacara, L., Mancuso, A., Ricciardi, W., & Specchia, M. L. (2016). The impact of electronic health records on healthcare quality: A systematic review and meta-analysis. European Journal of Public Health, 26(1), 60-64. https://doi.org/10.1093/eurpub/ckv122