Moving from paper to electronic medical records is a mammoth undertaking for small doctors' offices, but one that is crucial to methods of managing care that are focused on keeping people out of the hospital rather than just treating illnesses.

Meetinghouse Family Physicians, a three-physician practice in Marlton, started down the winding road toward fully electronic medical records about four years ago.

"We're getting there. The doctors have all bought into it," said Phyllis Downy, Meetinghouse's office manager, said

This year, Meetinghouse, which employs 17 people including the doctors, is gearing up to obtain a second level of certification from the federal government that it is making "meaningful use" of electronic medical records (EMR).

Meetinghouse's adoption of EMR places it in a relatively small group in New Jersey, where just 21 percent of office-based physicians had even a basic EMR system last year - the lowest percentage among all states, according to a recent report by the Centers for Disease Control and Prevention.

Joe Cerra, vice president of sales and marketing at STI Computer Services Inc., of Eagleville, which supplied Meetinghouse's EMR system, blamed the slow transition on the age of doctors in New Jersey.

"New Jersey is behind. We have a lot of old docs in New Jersey," he said.

"They've spent their whole career making their practice run efficiently on paper. Then we come in and we change everything with computers, and they have to relearn the process of how they process a patient through the practice," Cerra said.

About 30 percent of STI's customers who use the company's billing software say they are going to retire rather than switch to EMR, Cerra said.

Sloan A. Robinson, 65, who founded Meetinghouse in 1981 and has scaled back his hours in preparation for retirement, took a different approach. He decided to make the conversion to EMR his last great priority for the practice.

"It's a better way to practice medicine," Robinson said. "There's no question about that. It's safer."

Robinson's determination to change the practice - though he's not terribly comfortable with computers and laughs about not knowing how to turn on the laptop that showed up on his desk with the STI system - makes him what Cerra called a "champion."

"Typically, if you don't have someone with that kind of enthusiasm, it could fail, because if the boss isn't on board with it, everybody else lets it just linger," Cerra said.

That's understandable, given the amount of work EMR adoption entails.

"It's a lot of work," said another of the Meetinghouse doctors, Ronaldo de Guzman, 46.

"When EMR came out, we all thought it was going to make life easier for us. It's not. It's actually doubled the amount of work that we have to do, because we always feel like we're under the microscope of what we're actually inputting. We want to input things correctly, and we want to take the time to do it correctly."

The result is better documentation, said Downy.

The third doctor in the practice, Farah Roomi, is also the youngest, at 34. She has little experience working without EMR and appears to take it completely in stride. She's happy to no longer have the struggle of reading her colleague's handwriting.

Improving care through EMR is not as simple as turning on a computer.

One of the benefits of EMR is the ability to more easily track care, such as running a report on how many patients who were told to get colonoscopies actually got them.

But for some time, Meetinghouse doctors were recording colonoscopies in different places in the software program, making it impossible to get useful reports, said Karen Ruggles, who is care coordinator for Meetinghouse.

STI showed them how to fix that.

"Now all the doctors are recording information about colonoscopies in the same place, so we can run a true report," Ruggles said.