AOFAS member experience with computerization of the office

The combination of the implementation of the Healthcare Information Portability and Accountability Act (HIPAA) and the widespread publicity surrounding the report by the Institute of Medicine on preventable medical errors has increased interest of AOFAS members in the use of office-based electronic medical record (EMR) systems. Despite the large number of vendors for office-based EMR systems, little has been written to guide orthopaedists in the selection and installation of EMR systems.

A web-based AOFAS member survey was undertaken in the Spring of 2003, for the purpose of discovering EMR-related issues that are of most concern. Several questions were open-ended, so as to obtain the broadest set of answers. All responses were manually reviewed, collated, analyzed.

The 130 respondents were evenly distributed in age. Sixty-six percent were in private practice. Eighty-nine percent used a computerized billing system. Thirty-two percent used an EMR system. Use of an EMR system was more likely for those in academic practices (p = .01029, chi square) but was not statistically influenced by age, size of the practice group, or the number of offices or hospitals used in the practice. The opinions expressed were exceptionally varied. The most common potential benefit of an EMR system cited was the ease of chart handling and accessibility. The most common perceived barriers to successful EMR implementation were cost (50%) and training of staff and physicians (30%).

The survey highlighted the widely divergent opinions regarding the potential benefits (cost savings and improved quality of medical record) and barriers to implantations (e.g. issues dealing with mixed electronic and paper charts and managing the transition to an EMR system). The wide variety of opinions is partly a consequence of the lack of easily accessible information about office-based EMR systems and how to choose among the many vendors. A brief overview of the essential elements to be considered before acquiring an EMR system is included.