48 Practice Trends FAMILY P RACTICE N EWS • August 15, 2007 EMR Adoption ‘Awkward,’ Remains the Exception

BY TIMOTHY F. KIRN up to speed with appropriate software The electronic health record industry ly acceptable to my mind. If you want to Sacramento Bureau and hardware may be $5,000 for each one, and its products are geared to the acute use them, you have to adapt them,” Dr. and for the nation as a whole it may cost care environment, and when they can be Hamrick said. S EATTLE — Despite the government’s $50 billion, Dr. Bell said. used for a facility that cares for older per- When the Gurwin Jewish Geriatric push to encourage the development of the At the same time, those who are using sons, they need to be modified signifi- Center of Commack, N.Y., began to electronic medical record system, only a electronic medical records are finding cantly, the speakers said. look for an electronic medical record quarter of physicians keep medical records that they are not exactly time saving. In “As I was trying to figure out which system, the institution had no idea it electronically, and only 11% of hospitals part, that is because there is a learning electronic health records system we would take so long to find and imple- have fully implemented them, according curve involved. would use for geriatrics, I really ran into ment one, said Dr. Suzanne Fields, the to Dr. Karen M. Bell, director of the fed- The records also a lot of roadblocks,” medical director. eral government’s Office of Health IT generally require While it is thought that the said Dr. Irene Ham- The center found that there are Web Adoption. more information rick of the division sites (such as www.providersedge.com/ In addition, of the electronic record than what went into use of electronic health of geriatrics at East ehr_links_products_services.htm) that systems in use, probably fewer than half records previously, as records eventually would Carolina University, can help one find a system, and that the are fully operational, that is, able to take part of an effort to Greenville, N.C. American Academy of Family Practice notes, make lab and pharmacy orders, improve and ensure result in financial savings, “There really is has a rating form that one can send to and get lab results, said Dr. Bell at the an- quality. the start-up costs involved nothing out there vendors to get information on their sys- nual meeting of the American Geriatrics The government that is very good,” tems for comparison. Society. currently has public continue to be prohibitive. she added. And, the center found a number of “The reality of it is that adoption of re- policy advisory com- Her institution fi- products for long-term care. But, the cen- ally good functionality is really very low,” mittees to encourage more adoption and nally chose General Electric Company’s ter has both outpatient day care and clin- she said. to deal with privacy issues—significant Centricity system because it can be used ics, and inpatient beds, and none of the The barriers to widespread adoption challenges, Dr. Bell said. in many locations, such as the home for products adequately accommodated both, continue to be the lack of good, accepted In the meantime, her office is contin- health care visits. However, the institu- Dr. Fields said. computer applications, and the time and uing to develop an exact definition of tion found that it needed to tailor the sys- They, too, found that they had to cost, said Dr. Bell. what is going to be needed in an elec- tem for specific geriatric needs, adding adapt a system to their needs. In the end, Although it is thought that the use of tronic health record, she added. “There records of diet and activities of daily liv- the center combined two products, one electronic health records eventually would are no standard definitions for any of this ing, and changing the physical exam form for long-term care and another for physi- result in financial savings, start-up costs stuff.” to include sections for foot and mental cian care. The system is not yet up and continue to be prohibitive, she said. Other speakers at the meeting described status exams. running. The cost to get every record interface— the significant hardship they went through “Very little out-of-the-box software is “It has to be individualized. That’s what every office, laboratory, pharmacy, etc.— acquiring a system specifically for geriatrics. user friendly for geriatrics. None is total- I didn’t realize,” she said. ■ Hospitals Are Looking to Physicians Families Overriding Relatives’ As Partners Rather Than Employees Plans for Organ Donation O RLANDO — Patient wish- who had information on file BY JOEL B. FINKELSTEIN number of ambulatory surgery have tried to integrate physicians es for organ donation were with the DMV and whose fam- Contributing Writer centers has doubled to approxi- into more of the business deci- overridden by family mem- ilies had been approached by mately 5,000. sions, hoping to create a more bers in about 20% of cases, hospital staff for organ dona- WASHINGTON — Hospitals There are now almost as many comfortable environment for creating “missed opportuni- tion over the 3-month period. are getting smart instead of an- surgery centers as there are hos- them to work and minimizing ties” for organ procurement, According to DMV records, 25 gry about competition from pitals in the country. By compar- their desire to go off on their according to research con- individuals were listed as organ physicians. ison, there are own, Mr. Schaub ducted at a level I trauma cen- donors, and 59 had not desig- “A lot of care is moving from only about 100 ‘What we have said. ter in Charlotte, N.C. nated organ donation. the hospital to the ambulatory specialty hospi- “It is really in- Dr. A. Britton Christmas and For the 25 individuals who sector, some of which is still un- tals in the United seen over the last teresting how colleagues at the F.H. Sammy had designated themselves as der the auspices of the hospital, States, despite all 5-8 years is things come full Ross Jr. Center at the Carolinas organ donors, 20 consents for but increasingly into doctor’s of- the political at- circle,” said Mr. Fe- Medical Center reviewed 3 donation were obtained from fices, into physician-owned am- tention they get. tremendous instein. “Hospitals months of organ donation re- family members. Of the re- bulatory surgery centers, imaging Jeff Schaub, interest on the part were letting doc- ferrals at their center. They es- maining 59 individuals, 22 centers, testing facilities,” Dr. who rates acute tors partner with timated that about 17 potential consents for organ donation Robert Berenson, a senior fellow care hospitals of hospitals and them back in the transplant recipients did not were obtained. at the Washington-based think for the interna- systems to do joint mid-1990s, there receive organs because a pa- Although the organ recov- tank the Urban Institute, said at a tional credit rat- was a lot of scruti- tient’s previous donation in- ery rate was higher among press briefing on health care costs ing firm Fitch ventures with ny over this so tentions were overridden by those who had already speci- sponsored by the Center for Ratings, pointed physicians.’ everyone stopped family members. fied a desire to be donors (80% Studying Health System Change. out that when doing it, and now The research was presented vs. 37%), some families chose Physicians often set up these hospital leadership does not fo- here we are again and everyone is in a poster at the annual con- to override a previous designa- centers in part out of frustration cus on “what their physicians are doing it.” gress of the Society of Critical tion of organ donation. With with hospital bureaucracy, but doing and want to do, we have There are similarities, but some Care Medicine. an average of 3.4 organs trans- also in response to economic seen dozens of places have their important differences this time The researchers examined planted from each eligible pressures, said Adam Feinstein, a outpatient surgery volumes cut around, Mr. Schaub said. charts to determine the appro- donor, the researchers estimat- managing director at Lehman in half because docs have gone “In the 1990s, everybody was priateness for donation, famil- ed that the five individuals Brothers where he coordinates out and put up buildings.” buying practices just because ial consent or denial for dona- whose consent was withdrawn the health care facilities research To counteract such trends, everybody else was buying prac- tion, and the number of organs by the families resulted in 17 team. “what we have seen over the last tices. Now what I see is a much transplanted from each donor. potential organ recipients who “Physician incomes have been 5-8 years is tremendous interest more strategic focus, whether it’s They compared their records would not receive organs. going down. They have been on the part of hospitals and sys- service-line related or to head off with data from the state de- —Mary Ellen Schneider looking to make up for the lost in- tems to do joint ventures with entrepreneurs splitting off or to partment of motor vehicles come, and they’re competing physicians, figuring that they focus on a particular geography, (DMV) related to organ dona- For additional information on more aggressively with the hos- would rather lose half the busi- hospitals in a lot of markets are tion designations. organ donation and the donor pitals,” he said. ness than all of it,” he said. being more selective than they The researchers analyzed in- shortage, visit www. Over the past 10 years, the Alternatively, some hospitals were 10 years ago,” he said. ■ formation on 84 individuals organdonor.gov.

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