The latest numbers from the CDC’s National Center for Health Statistics affirm that a majority of small practices do not have an EHR. Why is that?

One big reason is because small practices don’t have the management or technical infrastructure available to prepare for and handle the biggest challenges facing medical practices today.

What are those challenges and what’s that got to do with EHR implementation? According to the Medical Group Management Association’s 2011 “Medical Practice Today: What Members Have to Say,” the top five challenges of running a practice are:

1. Preparing for reimbursement models that place a greater share of financial risk on the practice
2. Participating in the Centers for Medicare & Medicaid Services’ EHR Meaningful Use incentive program
3. Dealing with rising operating costs
4. Selecting and implementing a new EHR system
5. Implementing and/or optimizing an accountable care organization

Two of the top five specify the EHR, and another two are indirectly dependent upon EHR implementation.

In a small practice, who is going to drive the EHR selection process? One or more of the physicians may have a high desire to get an EHR, but a physician’s day is already full. If the physician transfers time away from patient care to spend time on a thorough EHR search, that practice immediately loses revenue from that nonperforming physician.

And there are other questions to ask:

Is there anyone in the practice who has any expertise in a system selection process? Identifying appropriate vendors from a marketplace of hundreds for the evaluation process requires at least a base knowledge of available solutions along with some understanding of how they align with the practice’s needs.

The practice must also vet the vendors’ viability to assure that the product and support will be in place for the next 3 to 5 years. The practice needs to be able to evaluate references and negotiate implementation services (not just price). And, then there is the actual implementation of the EHR, which is more critical to the practice’s successful use than the system itself.

Does the practice have the management expertise to analyze the current operational costs and productivity benchmarks compared with projected operational costs and productivity during go-live and post go-live? Physicians expect a return on investment (ROI) from the implementation of a new system. It is necessary to know the practice’s current operating costs to determine if savings can be achieved with the acquisition and implementation of any technology.

Key performance indicators such as total support staff per FTE physician, square feet per FTE physician, medical revenue after operating and NPP (nonphysician provider) costs per FTE physician, physician work RVUs per FTE physician, percent of accounts receivable over 90 days old, and the adjusted fee-for-service collection percentage should all be trended prior to the EHR implementation and benchmarked post-EHR implementation.

Often in a small practice one physician or the office manager may be the one and only IT resource for the practice. Sometimes a small practice will call in a local computer networking/support company to install a new server or to trouble shoot problems that exceed the expertise in the practice. The challenge in a small practice is the limited knowledge base and lack of time to stay current with the ever-developing world of technology.

Does the practice have the human resource capacity to manage a new project? Implementing and optimizing an EHR in a practice is not something you can just add on to an already overburdened manager or nurse, or physician.

Implementing an EHR is a full-time position for at least three to six months even in a small practice. And, after that, the ongoing support (optimizing, implementing new releases and features, managing incentive program participation, etc.) will require about .20 or .25 FTE for the system guru in the practice.

The EHR guru will interact with the vendor, maintain knowledge and understanding of incentive and pay-for-quality programs, and be the go-to person for providers and staff using the application.

So, given the challenges facing medical practices of all sizes, is it any wonder that it’s a daunting task to select and implement a PM/EHR system in a small practice.

Securing outside help from experienced and knowledgeable consultants can supplement the practice’s infrastructure and improve the likelihood of a successful system implementation. But don’t ever believe EHR uptake is slow only because it costs too much.

Rosemarie Nelson is a principal with the MGMA Health Care Consulting Group.