Residency-training programs offer unique HIT adoption challenges

While electronic health record adoption offers the promise of financial rewards as well higher quality care, several factors in a residency-training program work against successful EHR adoption according to a study published in the October edition of Hawai'i Journal of Medicine and Public Health.

Ravy Reddy, M.D., from the Department of Family Medicine & Community Health, John A. Burns School of Medicine University of Hawai'i, Honolulu, outlined the University of Hawai'i Family Medicine Residency Program at the Physician Center at Mililani's (PCM) effort to adopt EHR technology. Reddy identified five core challenges for residency training programs to meeting Meaningful Use:

  • Transient residents can contribute to fragmented charts: With residents being temporary employees with varying levels of experience, charts can become incomplete or fragmented as there is no economic incentive for residents to comply with Meaningful Use efforts. Additionally, once a resident graduates, it can be difficult to complete their unfinished charts.
  • Residency-based training programs have multiple part-time faculty providers with limited clinical practice time: This reality could lead to efficiency deficiencies with documentation of EHRs because patient volume is lower for faculty physicians.
  • Limited funding sources can cause EHR upgrade difficulties to achieve CCHIT certification.
  • Generally, physician/medical assistant ratios are lower in residency programs: With less staffing, medical assistants are less able to handle certain sections of charts such as medication reconciliation and demographics to contribute to meeting Meaningful Use criteria.
  • General deficiencies of charting: Reedy shared that at PCM, some common errors include incomplete smoking lists, unspecified smoking status and unlisted preferred language.

Reddy's essay adds to a bevy of literature on the challenges relating to Meaningful Use attestation. From CPOE to clinical summary and security issues, EHR adoption and attestation is no easy feat. Yet Reddy stated that while financial rewards are the primary benefit for beginning a Meaningful Use initiative, such efforts inevitably will lead to better care.

For example, recent research concluded that EHR use in physician practices was linked to improved patient care in the form of hemoglobin A1c testing for diabetics, breast cancer screenings and colorectal cancer screenings. At PCM, Reddy noted that EHR software upgrades that resulted in more security and efficiency.

"[D]uring the process of preparation for attestation, there has been improvement in completed notes, problem lists, medication lists, and other … documentation tasks that have resulted in better medical records," Reddy wrote.

Currently, PCM is in the process of attesting to Meaningful Use.

To learn more:
- read Reddy's article here (.pdf)