Richard J. Baron, MD
Acknowledgments: The author thanks the outstanding team of support staff at Greenhouse Internists, who did most of the work described in this article, and the Greenhouse physicians, Drs. Elizabeth Fabens, Melissa Schiffman, and Erica Wolf, who have been wonderful improvement partners in our EHR adventure. Finally, the author thanks Dr. Eric Holmboe for his helpful and thoughtful input on earlier drafts of this manuscript.
Potential Financial Conflicts of Interest: Consultancies: R.J. Baron (Mercer Human Resource Consulting). Grants received: R.J. Baron (Physicians Foundation for Health Systems Excellence).
Requests for Single Reprints: Richard J. Baron, MD, Greenhouse Internists, PC, 345 East Mt. Airy Avenue, Philadelphia, PA 19119; e-mail, firstname.lastname@example.org.
With 68% of all physician–patient encounters occurring in physician groups of 4 or fewer, improvements in small practices will be necessary to close the well-documented national gaps in consistent delivery of high-quality care. Many believe that adoption of electronic health records (EHRs) is the key to success, and that improvement will almost automatically follow. However, EHR adoption occurs today in an environment shaped by paper chart thinking, which may limit success. Having successfully implemented an EHR in their small practice, the author and his practice colleagues attempted to use it to support a simple project to improve their mammography rate. Although they achieved a real 10% improvement in their rate with only modest additional expense, their experience highlighted critical elements for success beyond the adoption of the EHR, including physician appreciation of structured data, the need for widespread adoption of standards, and a restructuring of the primary team with additional resources. An approach supporting EHR adoption along with these system changes could substantially affect public health.
Baron RJ. Quality Improvement with an Electronic Health Record: Achievable, but Not Automatic. Ann Intern Med. ;147:549–552. doi: 10.7326/0003-4819-147-8-200710160-00007
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Published: Ann Intern Med. 2007;147(8):549-552.
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