Reasons Why EMR Efforts Are Proceeding So Slowly

David Swink wrote an interesting comment on my previous post in which he lists a number of reasons why he thinks the EMR effort is proceeding so slowly. Since many of you don’t read all the comments on this site (I’ll forgive you this time), I thought I’d highlight his comments here to see what people think of his comments and what more they might add to the list.

Thought on why the EMR effort is proceeding so slowly:

1) EMR is much more complex than a simple inventory control system. The “human resources” apps probably come closest to the mark, but there are hundreds of separate HR apps out there, but they don’t have to talk to other HR apps.

2) Government is not good at organizing complex efforts. The government-sponsored HDTV effort took some 30 years to implement, and the results were largely irrelevant in that we’d moved beyond the concept of “broadcast”.

3) The medical community has no “IEEE” standards group to represent their interests and get various vendors to pull together towards a well-defined goal. The AMA could maybe assume this role, except that it is mostly a political organization, with only 17 percent participation by physicians.

4) Large medical groups are not likely to encourage mutual cooperation in EMR development. To them, small physician groups are competition. (Likewise, Sarbanes-Oxley works to the benefit of large corporations who can afford the accounting red tape, to the detriment of Mom-n-Pop organization, where red tape is a meaningful expense.)

I think David missed a number of other important reasons. Like the 300+ EMR and EHR vendors for a start. What else do you think is slowing the EMR effort? And more importantly, what can be done to overcome these challenges?

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

47 Comments

  • Maybe we should rephrase the question:

    “Are EMR efforts proceeding slowly?”

    The next question is: “whose efforts?”

    I would venture to agree that the government is slow in helping the industry come up with standards, but I am not sure about the private EMR industry being ‘slow’ with their efforts. As you’ve posted before, there are over 300 (and growing) EMR companies competing for a piece of the pie.

    Like your guest poster mentioned, the health IT industry is unique to other IT industries, but maybe a speed-of-implementation comparison list of other industries would help answer this question. Perhaps if we had a graph of “money thrown at problem” vs “speed of implementation” we could have an even more exciting discussion.

  • If I am a major health care system who has spent millions implementing an integrated ERP/EHR for my entire system including owned PCP groups… I”m going to want to make sure I’ve gotten every bit of reimbursement from the government I can given the limited funding for incentivizing EHR implementation.

    If that means stalling keeps the competition from getting any reimbursements before I’ve gotten all I can … then guess that’s bad luck for the small guys and my competition.

  • Nick,
    EMR vendors are trying to get market share as fast as they can. However, the 15% adoption rate of EMR software seems to be by definition slow. You might argue that they’re accelerating now, but healthcare IT adoption is well behind other industries. That’s the slow I think he’s referring to.

  • I agree that it would be nice to see faster uptake on EMR adoption. From a consultant’s point of view, would you prefer a super-fast adoption rate? If the other 85% of providers were seeking consulting for EMR implementation, would the EMR consulting industry be ready?

  • I guess I’ll have to think like an EMR consultant to answer that question. I think we’d be surprised how quickly people would adapt if there was that much demand for the services. Plus, the beauty of the market is that it works to fill the demand. Not to mention that people wouldn’t implement until the resources to help them were available.

    I also don’t think that most clinics really rely on EMR consultants that heavily. I think they rely on quality IT help (which there is plenty of) and the EMR vendor relationship. So, I don’t think there would be that much undue strain on EMR consultants. The better question might be would it place undue strain on EMR vendors. They have a much harder time scaling qualified implementation and support people. This is where we’d likely see a hard time if the EMR adoption changed over night.

    Although, this would definitely create a really defined moment for many EMR vendors. Those with easy to use, easy to setup EMR software would thrive while those clunky, “Jabba the Hut EMR software” would suffer under the strain of trying to support the unwieldy software.

  • We are slow to adopt because no one has shown EMR to be faster, more efficient, better for patient care, more helpful to the doctor patient relationship, or more able to reduce overall error when compared to pen and paper. If vendors want more business, they need to ask why they have been unable so far to meet our needs.

  • Many physicians are still skeptical that the government will actually pay out the Stimulus Money and the details of how they will get paid are still not defined. I think we’ll see a major increase in physicians adopting EMRs once the first physicians start to receive the Stimulus Money in 2011.
    Also when patients starts to realize that EMRs will better the point of care, they will want to use physicians that have adopted EMRs. So the consumer will help to drive EMR adoption as well but this may take a while for the consumer to realize the benefits.

  • I agree with all the above said points. And there is much more. To John’s comment about 300 EHR vendors, yes its like the wild wild days of 1920-40s when there were more than 100+ Automobile Companies manufacturing autos. Market will consolidate over time and better ones will survive the long run.
    Yes; the adoption rate is slow. Sales process, even to the smaller clinics is long drawn out and can take upto 3 months. Having said that, yes, adoption rate of EHR will accelerate over the next 12 months as more and more resources are trained and more consultants/experts are available to guide the medical community. With the billions of dollars that has been given out to the HIEs and RHIEs, these organizations themselves are looking for consultants and we see RFIs for consultants from these organizations frequently. These HIEs or other organizations who have received the funding, now have to get their act together to promote and acclerate the adoption of EHR. Its more like the end of the year before we can see any momentum from these efforts and monies allocated.
    Yes; there are many reasons for the delay in adoption of EHR. Lack of resources and especially senior resources is a real issue.
    On a similar note, I have had a number of requests from senior IT personnel from finance and insurance verticals (from Infrastructure as well as App Dev and Maintenance) for more information as to how to transition to HealthIT field. If any of you have any information please let me know. These are 1 level below C level personnel; and they have done what they have done in the financial industry over the last 25 years. And do have substantial experience on all aspects of IT.
    Thanks

  • Anthony,
    It’s such a hard thing to make a transition. Unfortunately, healthcare has been generally closed about allowing “outsiders” in from what I’ve seen. Not sure why it’s the case and might be part of the reason why adoption has been slower. Right or wrong, it seems that many in healthcare think that you need to understand the workings of healthcare to work in healthcare IT.

    I remember the first time I was hired in healthcare I was asked the question about my background and experience in healthcare. I quickly replied that I’d been to a doctor before (not the answer they wanted I’m sure). However, after a quick chuckle I’m sure I added on that I thought my project management skills and IT expertise would apply in healthcare (or something to that effect). With this said, I think they felt like they were taking a bit of a gamble on me since I didn’t know healthcare.

    One solution for the people you talk to, is to start a blog about healthcare IT. Have them start reading various healthcare IT blogs (I have a couple recommendations there) and have them post how their IT experience applies in healthcare. They’ll be amazed how much credibility they’ll have by saying they have a healthcare IT blog. It will show they’re interested in healthcare IT, show how their skills transition and give them a line on their resume that is healthcare related.

  • @ Brian Van Zandt…

    Practices are very skeptical they will see any incentivce payments from the Stimulus Act. Government interpretation of “meaningful use” demonstrated by a practice means there will bound to be many who are disappointed. However… IT companies will have made their money and were “stimulated”.

    As for your statement: “when patients starts to realize that EMRs will better the point of care, they will want to use physicians that have adopted EMRs.”

    Patients see physicians they can get an appointment with.

  • DK Berry,
    That’s true in some cases, but in larger cities there’s a lot of choice. Don’t be surprised if online scheduling and online prescription refills, etc become differentiators that patients will use in selecting a doctor. Those are best done tied to an EMR.

  • One major reason there is a slow acceptance of EMR systems is that many doctors have had bad experiences implementing the system into their workflow. The vendor essentially ‘dumps’ the whole system onto the practice. The key method is to ‘spoon feed’ the key EMR system blocks into a physicians workflow over a period of time, augmented by specific training for each block. People have to get familiar how each segment of an EMR system works before they accept it for their daily routine.

  • @Al

    I couldn’t agree more. This is exactly the reason my current client has abandoned two EMR products over the last few years. The EMR products were simply not made to handle their complex (and busy) oncology workflows.

    That’s why they’re spending money building one for themselves… getting precisely what they want.

  • John,

    The general # I see published of EHR vendors now is 800 (not 300). I estimate the real number is in the thousands with more to come.

  • Regarding Anthony’s automobile analogy: It seems to me that EMRs are still in the era before the internal combustion engine was the agreed-upon standard for cars, after which we could count on gasoline as the common fuel and (then) 6 volts as the electrical standard. A critical mass of suppliers of these consumables was reached, and the auto’s popularity took off. Henry Ford was the equivalent of my aforementioned IEEE, setting the de facto standards for the whole industry.

    In the 1970’s, minicomputers were very popular as a cheaper alternative to mainframes. Each manufacturer tried to lock in customers so that the could not easily migrate to another vendor. It didn’t help that ASCII hadn’t yet become a standard for text, and the 8-bit byte had not been agreed-upon as the basic unit for memory and storage. Customers were not happy about all this, but they couldn’t go back to the slide rule and they couldn’t afford a mainframe (also proprietary).

    Eventually the PC (in numerous flavors) came on the scene, and eventually became cheap and powerful enough to largely displace the minicomputer. But without the 8-bit byte and ASCII text as standards, PCs would likely not have evolved so successfully.

    Correct me if I’m wrong, but I suspect EMR vendors also have the proprietary “minicomputer” mindset and try to “lock in” their customer base with specialized formats and protocols, rather than distinguishing their products with ease-of-use and GUI wonderfulness. Customers are apprehensive, and (unlike minicomputer customers) feel they can sit back and let the dust settle before moving from paper charts (the slide rule) into a brave new world.

    EMR vendors need to ask physicians what concerns them the most:
    1) Initial cost.
    2) Recurring cost.
    3) Difficult to transition.
    4) Difficult to learn.
    5) Difficult to use.
    6) Vendor lock-in.

    I am an engineer by training, and working standards are way up at the top in importance to the customer, especially when significant effort and expense is involved. I suspect working standards are important to EMR users as well.

  • Hi John
    Thanks for the reply on advice to IT Professionals from financial vertical; I will certainly advice them on the health IT reading as well as blog. Yes its sad that there is so much talent out there in Information Systems and it can all be harnessed and will provide the additional resources required to bring healtcare current.
    On another note, I will agree that EHR will become a differentiator in years to come. Stimulus money is a gravy and has to be treated as such. Its easier to sell based on the merits of EHR (any EHR for that matter) as opposed to selling based on Stimulus Monies that are available. Its a stimulant no doubt to accelerate the adoption; but the Physician has to actually buy into this for the right reasons; stimulus money is not one of them. Overtime, there is no cheaper alternate to going paperless; it is by far the most efficient way to do.
    Yes; the UIs have to be improved and its going to take its time so that the demography of physicians in the age group of 45+ can use EHRs easily and navigate easily. One of the complaints, we hear very often from this demography of Docs: “I have to look at the patient in the eye when I examine; EHR requires me to look at the keyboard and type” (since these Docs are not very keyboard savy as reates to the age group under 40). UI and Usability are key components and these will evolve in EHR over the next months and years. And these new UIs will increase efficiencies, reduce the number of clicks the same way as (for lack of better example) Amazon’s One Click check out.
    Anthony Subbiah

  • Anthony,

    David Swink was close when he said, “EMR is much more complex than a simple inventory control system”, but IMO the problem runs much deeper. The problem (one of many) is that most HIT developers used and still use the same development practices for UI, workflow, and db design that are used for the “simple” systems. Your example, the Amazon shopping cart, is a good one. Here the use cases are very few in number, generally accepted across the board, very simple conceptually and administratively. Now, turn to EMR, where the patient could present most anything at any time, lives are at stake, human body systems are complex, security requirements are extreme (yet MU wants interop and patient engagement), and so on …

  • Agreed Axeo; its not as simple as a ‘One Click’ process. Nevertheless its a process and its a life cycle that EHR also needs to go through.
    Earlier someone had commented about the Physicians building thier own EHR; a better alternate is to partner with a EHR provider who can partner with and integrate the improvements desired by the Physicians; a EHR that can be easily customized by the Consultant or the Physician himself/herself.
    At the end of the day, although its HEALTHCARE related, its still a Workflow Process………. and can be done effectively and efficiently over time.
    And I agree to the earlier post; system has to be open so that any associate vendor can plug and play; and the system should have the capabilities to allow that flexibility.
    Anthony Subbiah

  • @John … There is the potential for more primary care capacity in cities than in rural areas… yet waits for appointments are routinely two months or longer. Do you consider on line scheduling and online prescription refills are components of an “EHR” that will attract new patients? That’s the value of an EHR? Scheduling a day that is already full … and refilling scripts? Really?

    @Anthony … you are exactly correct in one thing you said … echoing what John has said in other forums: “Its a stimulant no doubt to accelerate the adoption; but the Physician has to actually buy into this for the right reasons; stimulus money is not one of them.” Very well stated.

    Other elements of your post though reflect what many IT professionals misunderstand about the diversity of the health care industry. Physicians are not the tall pole in the IT challenge … the tall poles are the thousands of administrative and clinical staff in clinics, labs, pharmacies, group practices, and hosptial wards. I’m over 60yo and I’m not challenged by IT innovation.

    To the general audience… the problem with health care is capacity. The political debate over the past year was about expanding physician access. Politicians and academics viewed the problem to be one of insurance coverage when in reality the problem is one of system capacity. As discovered in Massachusetts after it implemented univeral care … there is insufficient primary care capacity to meet the needs of the population.

    If PCPs are seeing 4 – 5 patients an hour w/out EHRs … will EHR implementation be able to ensure the same or higher throughput? Adopting an EHR will increase the throughput by what percentage top line growth … and at what cost recognizing that EHR implementation takes approximately two years to be carried out.

    Physicians are being asked to take the business risk and the cost of implementing technology which has not proven to improve their business operations, clinical outcomes, or the physician’s quality of life.

    If EHR is so necessary for the nation to improve quality of care and reduce the cost of care … then it would have been smarter to the governement to pay for EHR implementation up front and reap the benefits in the quality and lower cost metrics.

  • DK,

    Agreed re: Stim Act and HITECH. Kind of convoluted the way the money flows. Would have been an interesting meeting when that was decided.

  • Anthony,

    I respectfully disagree. At the end of the day it is NOT a Workflow Process, if you mean “workflow process” as generally and historically defined and addressed by the incumbent software tools, platforms, practices, and methodologies. That’s the rub. A shopping cart, CRM approach — pick lists, templates, forms-over-data, …, won’t work for many providers.

    MU magnifies the complexity dramatically. Especially the interop requirement. Many vendors are offering guarantees. Guarantee what?

    15% adoption rate — the market has spoken.

  • It is true that there will always be a ‘workflow’ framework and a software design process centered around leveraging existing software for new workflows, but that doesn’t mean all strategies of ‘molding software to the workflow’ will work.

    At some point the differences are so fundamental that in order to create effective software more than just conforming is required.

    Heathcare workflows will have to be atomized in order for software to be beneficial. You wouldn’t expect a mom and pop local bank to be productive/cost-effective with stock-trading software from Goldman Sachs just because they are both in the financial sector!

  • Nick,

    In a word, “yup”.

    Contact me sometime regarding the EMR patent issue. Anything there in your opinion? I have not had a chance to research it.

    Jack

  • The RECs will be choosing the complex and expensive EHR products because they have no clue how a real PCP office that has a large Medicaid population works.

    Most of the charts look like:

    Patient c/o cough.

    HTN -controlled
    DM – controlled
    CHF – stable

    No change in meds.

    That is basically all the EHR has to do for routine visits which is the majority of the charting taking place.

    If the doctor can do this with a few clicks they will use the EHR. Also, if the EHR can be set up so Healthplans and Medical Groups can log in remotely and access their charts, then the doctor’s office won’t have to allow annoying chart reviews to be done in their offices

  • Computers and the applications developed can work well for quantifiable data. Health care is not so simple. Patients present with a story that may require a prolonged discussion to learn the nature if their complaint, and to explain options and answer their questions or concerns.

    I think the problem is less with EMRs than with the effort to foist this ill-suited process of digitalizing everything on healthcare. There is a reason we communicate with words and numbers. Think, for example of the thousands of ICD codes available and the cumbersome process of searching to attach a diagnosis to a patient. Does this level of granularity really add to the quality of patient care? EMRs seem much an extension of this misguided effort toward digitalization.

    Finally, I find it odd that we should wonder why EMR adoption is slow when one can read daily about the perils of electronic communication systems. Think: hacked credit card accounts, automatic withdrawals for excessive amounts from checking accounts (opps, M’am we deducted $400 rather than $40 for your electric bill – true story) and finally how about WellPoint’s excessive rate increase attempts in CA attributed to a computer error.

    Why should physicians, who invest and train years to develop the required cognitive skills to address difficult and complex problems now trust an EMR and more importantly the process it promotes???

  • Imemod,
    I really appreciate your thoughtful comments. They are well thought out and definitely should be considered.

    Here’s a few links that I think you’ll find interesting.

    As far as patients telling you a story, I think you’ll enjoy this short video by MModal about the value of the narrative alongside granular data elements: https://www.healthcareittoday.com/2010/03/10/video-of-mmodal-at-himss/

    I think everyone can agree with you on the value (or lack therof) of ICD-9 codes. Although, I think you’ll find what one EMR vendor did in their EMR software that took the useless ICD-9 and added value to the doctor: http://www.emrandehr.com/2010/05/13/benefits-of-icd-9-codes-and-how-emr-can-improve-them/

    In response to your final question, I think you’ll find this comment from a doctor pretty interesting about why technology (like an EMR) is close to becoming a necessity when practicing medicine: https://www.healthcareittoday.com/2009/05/20/body-of-medical-knowledge-too-complex-for-human-mind/

    I don’t even have to write things now. Just link to previous posts I’ve done;-)

  • “I don’t even have to write things now. Just link to previous posts I’ve done ;-)”

    At the speed that things move relative to EHR/EMR national regulatory guidance and system deployment … you could shift some of your time to blogging about Major League Baseball. Never run out of topics to post about there.

  • Jack F’s comment was exactly on the mark.

    Most of the charts look like:

    Patient c/o cough.
    HTN -controlled
    DM – controlled
    CHF – stable
    No change in meds.

    Those 5 short lines of text are the culmination of a clinical encounter and represent the result of a highly trained professional’s observations, conclusions and treatment plan. With the inclusion of patient name and date of service those 5 lines are the “Complete Medical Record” of that encounter. When Medicare or any other payer shows up to run a chart audit that’s all they want to see. There are certainly other documents like lab results that clinicians use in diagnosis and formulating a treatment plan, but those are simply part of the data “considered” by a clinician and are typically used once. That along with the more signifigant cognative data are processed through the clinician’s brain with the end result being output represented by those 5 lines of text.

    When EMR products are designed around that work process EMR ubiquity is possible.

    “Meaningful Use” is “meaningless” to clinicians.

    “Practical Use” is easy to define, just ask a bunch of doctors who are resistant to the current generation of EMRs. What capabilities should an EMR contain at a minimum that would make it a “I’ve got to have that” clinical tool.

    Here’s my list:

    1. Must contain a textual clinical note.
    2. Must contain a contextual/collaborative problem list.
    3. Must contain a contextual/collaborative medication list.
    4. Must allow access across enterprise boundaries.
    5. Must not interfere with my existing documentation methodology.
    6. Training should take no more than a coffee break.
    7. Cost must be trivial like my cell phone service
    8. Must not interfere with billing and administrative staff’s activities.

    I already know how to write a clinical note.
    I have finely honed cognative skills, don’t distract me from using them.
    I already have a practice management and billing system.
    I already get lab results electronically.
    I already have e-prescribing.
    I am not interested in drawing stupid little pictures on a screen with a mouse.

    Finally an EMR must create a secure open channel of communication between clinicians.

    I not going to spend $2,000 much less $100,000 to organize and share that information.

    Doctors are not Technology Averse, they are Stupidity Averse.

  • Thanks for sharing Wyatt. A very interesting take. I disagree with you on some finer points, but you’re right that many of the EMR software out there aren’t very good.

    Your second to last line also hit me strongly. Reminds me of what I’ve been preaching for 3-4 years now. EMR vendors need to focus a lot more effort on finding the benefits to doctors. If doctors can’t see the benefits of an EMR, then they’re just not going to adopt it. And quite honestly, they shouldn’t. Once the benefits to an EMR are completely transparent and must haves, then we’ll see widespread EMR adoption.

  • Dr. Hendricks – great precise comments. All you require in EHR is simple and can be done; training part of it – during a coffee break – probably that’s just an anology and you don’t really mean it. 1 to 2 hous of training should be good. Cost can also be contained and is currently. Yes you can compare it to the Cell Phone; that’s not an issue.
    Costs add up if the customizations you request need to be integrated; you have a PMS and Billing system which you and your staff are comfortable with; now the EHR has to be integrated with those systems so that the data interface integrity is maintained and requirement for data entry in two systems can be avoided. Yes, that adds to the cost. Its the same with other interfaces as well. Our experience is, if you are comfortable with the current PMS and Billing system, explore the opportunity to work with the same vendor, provided they are committed to EHR space (and many of them are getting there). Then it will be a seamless integrated and comprehensive system; just make sure that the EHR from PMS vendor also has the ePrescription module and generally the interface costs with labs are paid for by the vendors.
    Your requirements related to simplicity and interoperability is there now and will get better over time. User interface is identified as key component to the success of EHRs; and towards that substantial work is being done and will continue well into the future.
    And finally the EHR has to be customizable and adaptable to meet the workflow requirements that have been established. Quite a number of EHRs are easily customizable in terms of workflow.
    I don’t believe Doctors are technology averse; they prefer technology to be simple and efficient in terms of ease of use, cost and time. And the industry, through free markets, is and will get there. There are many great, talented technology, process and business minds at work addressing these challenges.
    Your post was excellent. Would like you to elaborate more on ‘Enterprise Boundaries’? We, as a EHR Vendor/Solution provider take comments such as yours seriously and do address them where possible. That’s the reason for clarification.
    Cheers

  • I’m in the computer industry and married to an Internist. She had 5 hours of EMR training Saturday for their new EMR system and came home almost in tears. Bottom line is what currently takes her 15 seconds and a couple of bucks for transcription will now take 5+ minutes of her time – per patient. There will be no savings in time or personnel. She’s now looking at 2 hours or so per day just to type into the computer. The recommendation from the consultants was for the physicians to cut the number of patients seen by 50% until they master the system. Probably in excess of a month for that.

    Required new hardware throughout the office.

    Now instead of listening and interacting with the patient, they’ll be typing notes into a laptop. Eye contact with the patient – forget it.

    As an engineer prone to coming up with solutions, I suggested she get an egg timer and set it for 10 minutes every time she starts with a patient. Explain to them that out of a 15-minute slot, they get 10 minutes of doctor time and 5 of documentation. Oops, out of time and they have a couple more questions? Sorry, schedule a new appointment.

    Welcome to the new world of healthcare!

  • Rackmount,

    Maybe you’ve heard the United Health commercial where a background voice can be heard saying something like “my pizza parlor records are online, why not my medical records”. That would be a fair question if the patient only ever asked for 2 or 3 toppings from a list of 20 or so. 🙂

    In any event, structured data is in demand for various reasons. Why and what have been hotly debated.

    To a large extent, the problem lies with archaic pick-list interfaces over object-relational data models from the same companies, developers, tools, and methodologies that bring us pizza parlor software.

  • EHR is a must; and I believe there is no way to go back to the paper charts. Its about, how the move to electronic records can be made simpler for the physicians who decry change. I know change is difficult; it was difficult in the banking industry when it changed from paper based systems to electronic systems; the argument was more or less the same. Teller and Branch Managers were used to looking the client in the eye and chat; it took a few years and finally we are happy that the change happened inspite of the push back from the users. Its the same with the Health IT; HIT is in the stone age and needs to adapt to the current day and age and facilitate move to electronic health records sooner than later.

  • Oldy but goody topic …

    @Anthony… “no way to go back to paper charts”. Don’t think the docs have left paper charts … so going back isn’t the issue.

    Disagree that practices need to adapt to HIT… HIT needs to adapt to practices.

    Retail banking customer experience is not at all analogous to the PCP-patient exerpience. Do you propose that practices should just put up with EHRs which create a hurdle for the delivery of quality health care delivery at the practice level for a few years?

    Sounds like an ineffective, useless tail wagging the dog just to put treatment into an ordered data construct for some grad students in Cambridge to crunch into some useless metrics.

  • Hi Don, I am not comapring bank employees with Physicians; I am sorry if I came across that way. What I mean is that the Healthcare IT is so far behind the curve that it needs to catch up or more so the practitioners need to catch up at some point.

    Sooner the better; and its not for some statistician to crunch numbers; more so that the practices become more efficient in collecting data, pro-actively follow up with patients, use the capabilities of IT so that the Physician’s work becomes more easier to practice, patients have access to their data, eliminate paper where possible, collect structured data so that treding analysis can be performed and so much more. Nope, I do not for a minute suggest that Physicians do data entry for the sake of it; but they do so, in order to maximize the potential of IT in healthcare and leverage the benefits that so many verticals have already managed to benefit from.
    Change is difficult and if embraced can bring in the desired benefits; nothing come perfect intially but will become so over time through market forces. This is a great time and can be done with cooperation from the providers of healthcare.

  • Rackmounts comments really cut at me. Mostly because this happens far too much. Plus, I hate to hear about girls crying.

    To me the solution starts with the selection of the EMR software that doesn’t leave a person in tears. Sure, every EMR software takes some adaption and getting use to, but it never should be too bad.

    I still stick to my comments that if it takes a LONG time to train on an EMR system, then it’s very likely that said EMR system was poorly designed.

  • One of the issues we have encountered while implementing Ankhos is the natural resistance to change. Be it the transition to using computers or just a changing workflow, in general.

    But you can approach these problems with a positive light. Don’t force your users to use the EMR… persuade them. Show your users what you can do when patient information is in electronic form:

    Show them the value of immediate access to a patient progress note

    show them automatically-generated trends of a decreasing blood pressure

    Show them how to search for patients that might be eligible for clinical trials

    Show them reports about documented reactions to drugs

    Show them how to accurately capture infusion times.

    Show them alerts for allergies for patients.

    If you can’t demonstrate the value your EMR has, then it really might be worse than working on paper.

  • My wife’s office is finally starting to bring EMR live. Not going particularly well but not the end of the world. There are certainly benefits as Nick points out. However, you’d be surprised at how well your doctor knows you and doesn’t need EMR to remind them about your last visit. My wife can remember details from patients she hasn’t seen in a year and I think you’d find most doctors like this.

    On the other hand, EMR would really shine for allowing people outside the primary office, such as the hospital or specialist, to access the record. Unfortunately, EMR is like word processors when they first came out. Databases are incompatible and there is no apparent standards being implemented. It also opens up the opportunity for your record to be hacked or divulged by unknown persons. So – did you hear that has ?

    Being married to a doctor has brought a lot of enlightenment to me. Call your attorney in the middle of the night because you can’t sleep and find out how much that costs. Call your doctor – no charge. Compensation is determined by Medicare and insurance companies. Patients spend more on their pets than themselves. Etc. Etc….

    So EMR brings benefits to the patients and apparently is going to cost doctors a lot in lost productivity not to mention software and hardware costs. Do the doctors get compensated for this? No. Therein lies my beef with EMR. A 15-minute visit gets billed the same, regardless if it takes 1 minute to dictate or 5 minutes to use EMR.

    Last point is if you have been to a doctor using EMR, they generally spend the time ‘talking’ with you typing into a tablet. Not a great doctor-patient interface.

  • Above problems pointed out by ‘Rackmount’ is valid and is in line with the current thinking.

    Based on our experience, its easier to prioritize the functionalities of EHR required for the practice and implement them in line with the workflow process of the practice; while prioritizing, the simple rule is to schedule in such a way that the low hanging fruits are harvested and the benefits of EHR made visible to the organization to get the on-going buy in.

    Prior to the decision of EHR, benefits of EHR and why the practice needs it should be well established. If costs are a concern, that needs to be analyzed to see what benefits an EHR will bring; other than incentives what else. There is some savings on the malpractice premium in NJ. Does this add up; yes it does, starting with a 5% saving across the board for using a EHR.

    Yes, I agree, usually Docs know the patients so well that they remember their last visit an year ago; that’s beside the point. A sales person knows the client well; but still we insist that the information and encounters are documented in a CRM not because the Sales Person cannot handle the Client; but more so, that the data can be analyzed and a better service can be provided to the Client in future.
    I understand its still a pain to change; but it needs to be embraced to increase efficiencies over time. There is no better time than now…………..

  • Anthony …

    “Prior to the decision of EHR, benefits of EHR and why the practice needs it should be well established. If costs are a concern, that needs to be analyzed to see what benefits an EHR will bring; other than incentives what else.”

    That’s the whole point. Rackmount has said it and I have said it. Doc’s get all the costs, hassles, a cut in revenues, and no upside.

    All the so called benefits are payer benefits, patient benefits (some would say), and community/national benefits (someday). Provider … no benefit.

  • Yup, and terribly unfair to the providers. Isn’t Obama on record in front of the AMA questioning the profit motive of MDs?

Click here to post a comment
   

Categories