I love all the discussion that happens around EHR adoption. The funny thing about it all is that we honestly don’t really know. We don’t have any really solid number, because there’s no good way to measure EHR adoption. Plus, I think that we’d see drastically different EHR adoption trends based on location, practice size and specialty.
However, I think one thing is clear: EHR adoption has gone quite slow.
I read someone today talking about slow EHR adoption even in the midst of billions of dollars of incentives from the government. I think this is true. Even with all that money out there, doctors are still not adopting EHR software in droves.
Part of me says that this is a good thing. I think the worst thing that can happen to EHR is for a doctor who doesn’t want an EHR to adopt one. If they’re not on board with the idea of an EHR, then they just make work miserable for themselves and everyone around them. I see buy-in for an EHR implementation as the key determining factor for success of an EHR implementation. So, I don’t think we can force the issue.
As I consider this point, I was trying to think what movement or trend could make doctors want to implement an EHR in their clinic. One that popped into my head was insurance companies requiring use of an EHR. I know very few cash only doctors out there, so if they had to use an EHR to get their insurance payments, we’d see a drastic change in physicians perspective on EHR. Sure, some would still not like it, but they’d do it. I just don’t really see the path to where insurance companies will do this.
Another method will be if doctors start losing patients because they don’t have an EHR. We’re still a ways from this I think. I don’t think it’s clear in the consumer mind the benefits to them as a patient for the doctor to use an EHR. They’re going to get their prescription (or other healthcare service) either way. Should there be a new field on insurance companies list of providers that says “EHR User”?
What other trends could happen that would make EHR adoption basically a requirement to stay in business as a doctor? Thoughts on what could turn the tide. It seems the HITECH carrot and stick still isn’t totally moving the needle.
You scare me.
In one paragraph you say: “I think the worst thing that can happen to EHR is for a doctor who doesn’t want an EHR to adopt one.”
And then in the very next paragraph: “I know very few cash only doctors out there, so if they had to use an EHR to get their insurance payments, we’d see a drastic change in physicians perspective on EHR. Sure, some would still not like it, but they’d do it.”
If that’s not a contradiction, the next two paragraphs are: “Another method will be if doctors start losing patients because they don’t have an EHR.” And “What other trends could happen that would make EHR adoption basically a requirement to stay in business as a doctor?”
Did you develop indigestion in the middle of writing this one, John?
Well, my wife’s planning a Halloween event, so scaring is on my radar.
I don’t see them as contradictions, but I can understand the confusion.
My first point is that if a doctor hasn’t decided to do an EHR, then he shouldn’t. Then, the next 2 points are changes in the EHR and healthcare landscape that would make it so a doctor wants to adopt an EHR.
I could see how you could believe that those changing trends could be “forcing doctors” that don’t want to use EHR to use them is still a problem. That doesn’t mean that trends aren’t going to happen that will almost require EHR adoption. It’s amazing how motivations can change with the right pressures.
Reminds me of the GYN friend of mine who said he hated EMR. 3 years later I saw him and he said he was now using an EMR. My jaw dropped and so I asked him how it went since he was so against it. Long story short, he got on board the idea and after implementing it is really happy that he did because they’re making a lot more money with it.
I think adoption is moving along fine John. It is the first year of the carrots and a redundant one too since adoption next year will still result in the same total. We (Practice Fusion) are bringing on more than 500 users a day at his point, so at that pace it won’t take too long for EMR adoption to be pretty broad. Certainly well in front of the sticks coming out. And we continue to hone the EMR as time goes on as well, hiring the best user experience designers in Silicon Valley to help. When I look at technology adoption curves, 2011 looks about right as a good start to me and 2012 is going to be an even bigger year. I was involved in rolling out online banking a decade ago, and it followed a very similar adoption curve, but today we take it as a given.
Paul,
We’ll see how it plays out, but I think the EHR adoption is hard to compare to the online banking since it’s doctors adopting something, not consumers.
Your points are well taken, John. I just think it would be much better for healthcare if providers choose to purchase EHRs because they are safer than paper and guarantee a return on investment… rather than to be beaten with a stick by HHS, insurers or even consumers.
Providers know the needs of their businesses better than anyone. You’ve got to respect that.
I don’t think that’s completely true D. Kellus Pruitt. The story I told above about the GYN shows that he didn’t know that EMR was better for him until after he implemented it and saw the benefits.
On the other hand, John, what percentage of EHRs are voluntarily de-installed these days? Is it still around 30%?
I can see how physicians with tens of thousands of patient records and even more lab reports could easily fall in love with their EHRs. I also imagine that some systems in large offices even pay for themselves and are relatively safe for both providers and patients… as far as we know. (A couple of days ago, HHS revealed it underestimated recent data breaches from healthcare facilities by half).
However, one thing EHRs don’t do well is scale down for smaller practices with less manpower than multi-physician offices. Just ask a rural physician.
Bottom line in the land of the free: If a business tool offers the purchaser no return on investment it’s called a hobby. And if the tool also exposes the purchaser to more danger than a cheaper tool with a long track record, it’s called a foolish hobby.
What’s more, mandates are tyranny. Nothing good ever comes from tyranny.
It’s a good question. I think the number of failed installs might still be 30% with some of the older legacy systems, but many of the newer ones have seen the fall out from all the failed installs that they’re going to great lengths to ensure a high implementation success rate. They know they’re going to be asked that question, so they work hard to do it right.
Kenneth J. Terry posted “The EHR Feature Doctors Hate Most” on Medscape a couple of days ago.
http://www.medscape.com/viewarticle/750110
Cindy Dunn, an MGMA consultant is quoted: “There isn’t a physician I’ve run across who has gone to EHR who wants to go back to paper.” She says EHR functionality and the accessibility of data still outweigh the downsides for most doctors, but warns that that could change if the requirements for stage 2 of Meaningful Use are too stiff.
Is there an aggregate total for all 60 RECs re number of providers that have been signed up and what those represent as a percentage of all eligible providers?
It seems clear that EMR adoption is going very slowly, in spite of HITECH incentive payments and future cuts in Medicare and Medicaid reimbursements. This suggests that non-financial, technical or care delivery workflow or HR/skills issues are the primary obstacles to the move from a paper-predominant environment to a paperless one.
Perhaps RECs are the right vehicle for delivering the knowledge for implementing EMRs, but they need to be tweaked or rejiggered more substantively to get EMR implementation knowledge in timely fashion to providers. Thoughts on whether ONC or (majority) of RECs can accelerate the rate of adoption?