Payment Reform and EHR Adoption

In a recent comment by Bobby Gladd (check out his REC Blog), he makes a really interesting connection between the need for healthcare payment reform and EHR adoption. Here’s his comment:

I would just observe that, absent significant payment reform (I won’t be holding my breath), there’s a very real problematic barrier to effective EHR use if we don’t change the basic paradigm. For example, fundamental to the concept of the “patient-centered medical home” trial initiatives now getting underway is the argument that primary care docs should properly be seeing no more than 8-10 patients per day (e.g., think about the typical hour attorney consult visit), that the customary 25-30 pts/day is driven by the need to bill, to keep the doors open; that roughly half of outpatient visits are of marginal to nil clinical value.

I and one of my REC colleagues did a clinic assessment visit the other day. We interviewed 4 docs, one of whom was a severe Dr. NO!” on the topic of HIT. His beef was basically a “productivity loss” complaint, i.e. that seeing mostly older, complex problem list pts (he’s Internal Med) made it nigh impossible to effectively chart electronically in within the scheduling constraint.

Now, perhaps with a lighter, more rational daily patient load (and more extensive EHR training) he might come around and truly “adopt.”

I consulted with an attorney a couple of years ago regarding legal guardianship over my dementia-addled (now late) Dad. The initial hour cost me $300. The entire deal ended up costing about $4,000.

A physician, however, is supposed to take in myriad data and make a comparably expert decision in 15-30 minutes — and hope he/she can eventually get reimbursed a relative pittance.

It’s crazy.

So, OK, where are we? We’re facing a current and projected shortage of perhaps 40-50,000 primary care docs, and under PCMH theory we propose to cut their pt volumes in HALF ore more so they can provide better care? All while bringing tens of millions of the previously uninsured into the (non-ER) system under Obamacare reform.


I don’t have a good answer for the skeptical docs who argue that the EMR gold rush is more about billing imperatives and vendor welfare, that the docs’ pt care-analytic needs are a distant 3rd at best.

It’s a vexing circumstance.

My only comment to the “productivity loss” complaint and the EMR gold rush that he refers to at the end is…
Maybe they’re looking at the wrong EMRs. Unfortunately, the EMR stimulus does promote mostly the wrong EMR vendors. That’s why the EMR selection process is so important.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the, 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,, 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.


  • Productivity is a real concern when charting can take up to 15 minutes to follow the prompts and complete the electronic medical record in a thorough and “meaningful” way. That 15 minutes spent is equivalent to seeing another patient.
    In addition to productivity, there is an increased risk and reduced proprietary value of the doctor’s work.
    Doctor’s consider their diagnosis to be proprietary information. If all of their knowledge were immediately auditable and admissible, there would be increased lawsuit risk to the doctor and reduced demand to transcribe their dribble; Doctor’s get paid up to $10k to offer depositions.

  • Stephen,
    Thanks for your comments. Productivity is a real issue for sure. Although, not all EMR software will cause a productivity hit. In fact, some will improve productivity if used the right way. Meaningful Use on the other hand, could be a different story. We’ll see once we get some practical details.

    There are definitely many places that an EMR might not be good as you mention. The key is to mitigate those as much as possible and capitalize on the benefits of an EMR: Unfortunately, Meaningful Use and the EMR stimulus cause people to forget about this strategy.

  • Why has SaaS not taken over in the Healthcare IT world? With so many new regulations and expenses…and most hospitals struggling to make money…why are they implementing such incredibly expensive solutions?

  • Too many deep pocketed IT vendors that can buy off the top IT people at the hospitals. Ok, that’s a bit cynical, but sadly not far from the truth in many cases.

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