Electronic health records: just around the corner? Or over the cliff

We recently implemented a full-featured electronic health record in our independent, 4-internist, community-based practice of gen-eral internal medicine. We encountered various challenges, some unexpected, in moving from paper to computer. This article de-scribes the effects that use of electronic health records has had on our finances, work flow, and office environment. Its financial impact is not clearly positive; work flows were substantially dis-rupted; and the quality of the office environment initially deteri-orated greatly for staff, physicians, and patients. That said, none of us would go back to paper health records, and all of us find that the technology helps us to better meet patient expectations, expedites many tedious work processes (such as prescription writ-ing and creation of chart notes), and creates new ways in which we can improve the health of our patients. Five broad issues must be addressed to promote successful implementation of electronic health records in a small office: financing; interoperability, stan-dardization, and connectivity of clinical information systems; help with redesign of work flow; technical support and training; and help with change management. We hope that sharing our expe-rience can better prepare others who plan to implement electronic health records and inform policymakers on the strategies needed for success in the small practice environment. Ann Intern Med. 2005;143:222–226. www.annals.or