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We Self-Diagnose Our Car, Why Not Our Health?

Posted on July 29, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today my wife went out to move my car and came back to tell me that my battery was dead. This is a common thing in Las Vegas since it’s so dry it kills batteries regularly. However, I was intrigued that my wife with no training as a mechanic had diagnosed the health of my car and rendered a diagnosis. I’ll be going to check that indeed it’s the case. If jumping my car doesn’t last, then I’ll have to take the battery in where they’ll run the battery tester to confirm her diagnosis.

When I take the battery in, the mechanic won’t question my diagnosis. He won’t feel like I haven’t trained long enough to know if the battery might be the problem. He’ll run the tests to verify what I’m saying, but he’ll work collaboratively with me to fix the problem.

Why is it so different in healthcare?

In reality, it’s not that different. We’ve been self-diagnosing in healthcare for a long time. There’s a whole industry of over the counter medications that anyone can go and take to treat their health condition with no doctor involvement at all. We self diagnose and self treat with no intervention from the doctor at all. Why then do so many doctors (not all of them) balk at the idea of the patient working to understand their issue and identify their diagnosis?

I think there’s two reasons that this scares doctors. First, a minority of patients have ruined it for the rest of us. Some patients go into their doctor and are completely disrespectful. They treat the doctor as someone who should just give them whatever they want and whatever they ask for. It’s shameful and a few of these “bad apples” will no doubt make a doctor gun shy when the next patient comes in respectfully talking about their own efforts to diagnose their issues. We can’t let a few bad apples spoil the bunch.

Second, the tools we have available today have opened up so many new worlds for patients to be able to be more informed about possible health issues. This starts with Dr. Google which is literally available to us at our fingertips or even at our beck and call (ie. Siri, Alexa, Google, and Galaxy). It continues with this wave of health sensors and health apps which help us better understand our own health and possible health issues we may be experiencing. Both of these are only going to get better. Before we might diagnose a fever but with new technologies we might eventually be able to know if we have diabetes or some other more complex disease. It’s not hard to see how patients will know more than doctors about their own individual health. This is scary, because with increased information and data we can do so much more. However, with that power also comes new risks.

Going back to the car analogy. A dead battery is something pretty easy to diagnose in a car. I’ve even had enough experience with cars that I could probably diagnose an alternator problem. However, while I could diagnose the problem, I certainly am not capable of fixing the problem. Plus, it’s possible that the mechanic might replace the alternator and there are still problems or I might suggest that it’s a problem with the alternator, but they find something else which is really causing the problem because they understand how a car works better than me.

We’re going to find a very similar experience in healthcare. We may be able to eventually know that we’re a diabetic, but we’ll need the healthcare system and doctors working collaboratively with us to actually fix the problem. Plus, we may think we’re a diabetic, but once we see the doctor we’ll find out that what appeared to be diabetes was something else that had similar symptoms. That’s ok and normal. Much like we wouldn’t freak out at our mechanic for finding a different diagnosis, we shouldn’t freak out at our doctor.

The reality is that healthcare must be a collaboration between patient and doctor. Neither should feel so arrogant that they don’t listen to or disrespect the other. Patients should present the doctor with their symptoms, experiences, and findings so that the doctor has as much information about your health needs as possible. Doctors should be excited to have a patient that’s deeply interested in their health. Together they can work through the findings to help everyone understand the best path forward and why something the patient found might not be accurate or appropriate for them.

The very best doctors I know love this type of collaboration with their patients. They also hate when patients arrive in a disrespectful and arrogant way. We need to purge the later from the system so that they don’t ruin it for the rest of us and the doctors.

A Look At RECs Success or Failure

Posted on July 28, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

ONC has recently put out a report evaluating the performance of the REC (Regional Extension Center) program. The report is only 124 pages, so you might want to save the light reading for the weekend. If you want something more consumable, you can read this blog post from Thomas A. Mason, MD which includes this nice summary:

Survey data included in the report released today indicates that 68 percent of the eligible professionals who received incentive payments under Stage 1 of the incentive program were assisted by an REC, compared to just 12 percent of those that did not work with a REC. The survey also found that many providers working with RECs received frequent and tailored help – often face to face, for as long as it was needed. Many RECs also created both structured and informal opportunities for clinicians to learn from one another, creating economies of scale to reach more providers with limited resources and spread providers’ EHR product-specific knowledge.

In the same blog post he also points out ONC’s numbers that “nearly all hospitals and approximately three-quarters of doctors reported using certified EHRs.”

That all sounds like a success to me. All these rosy numbers about people being helped. Lest we think this report doesn’t matter, HHS has already announced another $100 million over 5 years for what I’d call REC like support money for those participating in MACRA. I expect many of the RECs to get this money, but we’ll see.

What’s clear to me is that these REC organizations did indeed help many organizations get access to the meaningful use money. Only in the government could you spend money to get people to have you spend more money, but I digress. Most of the REC organizations that I met with really did a lot to help small practices with the meaningful use program. Some of their EHR selection efforts could be questioned, but not the MU help they provided. I can’t remember how many posts I’ve written about the random methodology that RECs seemed to use in their efforts to help their clients choose an EHR. It was a mess and full of weird influences (Note: There were some exceptions where certain RECs just supported everyone and every EHR or at least did a good job having their clients drive the process of which EHR to support).

When you look at the recent study be Deloitte that many doctors don’t know about MACRA, that could partially be because the RECs did a lot of the meaningful use education for doctors. We don’t have that yet for MACRA.

Personally, I’m torn on how valuable the RECs have been to the progression of health IT. Did they really help practices choose the right EHR and implement it in an effective way? What would have happened if they weren’t there? At the end of the day, the cost of the RECs is small potatoes next to the billions we spent on meaningful use. I’m sure some rural practices would have never considered participating in meaningful use if it weren’t for the RECs. No doubt that’s who the politicians are thinking about when they included the money for RECs and now for MACRA support.

The harder question to answer is if healthcare is better off with all these rural practices being “meaningful users” of EHR.

Finding Value in the #HIT100

Posted on July 27, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The #HIT100 has come to a close with plenty of controversy and discussion about the details of “the list.” In fact, there are two lists you can enjoy perusing. I’ll leave the controversy for someone else. As I mentioned when I hosted the #HIT99 last year, I’m not that interested in the ranking on the list. With just my own health IT Twitter accounts I could get someone in the top 75 (it was top 50 last year, so that’s an improvement as far as involvement) and so it’s easy to see how the system can be easily gamed. Such is life with any crowd sourced list. I’ll leave that to the data experts.

Instead, I find the most valuable parts of the #HIT100 in the nominating process itself and in the social discovery of everyone that’s nominated.

When it comes to the nominating process, it’s amazing to share and be shown gratitude. I believe in the power of gratitude and the #HIT100 is a great time to express appreciation to so many of the people on healthcare social media that have affected your life. Given the state of society, a little gratitude and recognition is a really beautiful thing. We need more of that, not less of it. I’m glad that most people enjoy the gratitude and don’t get lost in the competitive aspects of it.

As far as social discovery, I probably know or have seen most of the people in the top 100 of the #HIT100. Seeing them on the list is nice, but it doesn’t do much for me if I already know them and interact with them on a regular basis. That’s why I like to look beyond the Top 100 so I can discover new accounts I probably had never seen before.

For example, I like to look at the people who only got one #HIT100 nomination. There were 606 by my count and a bunch of them I’d never seen before. Some of these extraordinary accounts like @halletecco, @heatherhaugen, @histalk, @hospitalEHR, @healthITPR, @janoldenburg, @jenwebs, @jimmyweeks, @missykras, @naveen101, @pjmachado, @rrowleymd, @thedocsmitty, @thegr8chalupa, @davisjamie77, @davidblumenthal, @anthony_guerra, @annezieger, and @aneeshchopra all only got 1 vote and I’m sure that many of my readers don’t know them, but should. There are a lot more like them that can be discovered in the full list of people that were nominated to the #HIT100 (by my numbers it’s 921 people nominated total).

Since I find such value in the new account discovery that can happen by looking at anyone that’s been nominated to the #HIT100 or anyone that’s nominated someone to the #HIT100, I took @shimecode’s data and created this spreadsheet of everyone that was nominated and everyone that nominated someone else. There are a lot of incredible Twitter accounts throughout the list that are worth adding to your followers.

As has been noted by many people, there are a lot of people that impact healthcare and health IT that aren’t on social media or Twitter. That’s true and it’s ok. The #HIT100 is about those that are on social media. We could start a whole other list of people who aren’t on social media, but that would be a different list. In fact, maybe we should start a list of people we wish were on Twitter that aren’t. That would be fascinating.

All in all, I know that @theehrguy and @shimcode put a lot of work into processing the data for #HIT100. Which list is right and which list is wrong? The more I’ve thought about it, the more I don’t care. I’ll stick to enjoying the gratitude and social discovery that still exists in the #HIT100. Now, time to go through the list and see who else I should start following.

Physician Burnout

Posted on July 26, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

At the HIMSS Annual conference, I talked with Vishal Gandhi, CEO of ClinicSpectrum, about a popular topic at the conference and well beyond: Physician Burnout. You can watch the full video interview I did with Vishal below:

Physician Burnout is such an important topic and I love that Vishal commented that physician satisfaction (the remedy to burnout) is good patient care and an appropriate reward. As it is today, the trend is to ask doctors to compromise good patient care and we’re paying them less in the process. Is there any wonder why physician burnout is so rampant?

Vishal also commented that healthcare technology is used more for documentation than patient care. He argued that the tech piece has focused far too much on documentation as opposed to focusing on the patient. I’d argue that if we focused the tech on the patient, doctors would appreciate technology much more and would be less burnt out.

Finally, I’m always interested to hear what non-EHR technologies Vishal and ClinicSpectrum have launched to make a practice more efficient and profitable. He outlines a bunch of them in the video above. Take a listen and see if some of them can make your life easier and your practice more profitable. It’s time we start considering technology outside the EHR that can make a practice better.

What is MACRA? – MACRA Monday

Posted on July 25, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As we mentioned at the end of last week, we’re excited to start a new series of blog posts called MACRA Monday. Over the next months (and possibly year(s)), each Monday we’ll step through the MACRA legislation and share the details of MACRA with you the reader. Many of you might have read our Meaningful Use Monday series which we wrote for a couple years leading up to meaningful use. This will be similar. You can find all the latest MACRA Monday posts here.

Before we begin, it’s worth mentioning that CMS has posted all the latest updates and details related to MACRA here. That’s largely where we’ll get our information for this series, but hopefully we can provide it to you in a more digestible format. Plus, we’ll add in our own opinions, views, and comments that will hopefully add even more value. At the end of the day, like it or not MACRA and value based care is heading your way. Knowing the details about it will better help you make decisions for the future of your practice.

In all of the CMS presentations on MACRA, they always start off with a slide that includes the same image. So, I thought it would be appropriate to start off MACRA Mondays with this image as well.
CMS Move to Value
No matter what happens to MACRA and other government programs, this slide illustrates the goals that CMS wants to achieve in healthcare. They want to shift the reimbursement from the current fee for service model into alternative payment models that pay for quality and value. CMS has said that they’ve already achieved their 30% goal for 2016. I think they’re being generous with their numbers, but that’s a topic for another day. Regardless of the details, CMS has clear goals to shift the healthcare system to a value based care model. MACRA is one major element of that effort.

What is MACRA?
The recent study by Deloitte found that a large portion of doctors are unaware of MACRA. Some had heard of MACRA, but didn’t know any more details. That’s a pretty scary thing considering MACRA will impact most ambulatory practices that participate in Medicare.

At the core of the MACRA legislation was two main goals: replace the Sustainable Growth Rate (SGR) and create a single framework – quality payment program. In the case of SGR, MACRA was the long-term solution to the annual “Doc Fix” or “SGR Fix” which literally shut down our government as congress debated how to address it. Along with replacing SGR, MACRA also streamlined multiple quality reporting programs into APMs (Advanced Alternative Payment Models) and MIPS (Merit-based Incentive Payment System).

We’ll talk in more detail in future MACRA Mondays about which programs ended up where and what they look like under MACRA. For now, we’ll just say that the new APM and MIPS programs consolidated programs such as PQRS, the Value Based Modifier, Meaningful Use (Officially called the Medicare EHR Incentive Program), ACOs, and PCMH to name a few.

Before I end this intro to MACRA, it’s worth noting that the MACRA rule is still only a proposed rule. So, everything we talk about now is talking about what’s part of the proposed rule. Certainly, any and all of this could change. The MACRA comment period ended June 27, 2016 and CMS received 3,710 formal comments (some of them extremely lengthy). However, given past changes to proposed rules (or lack thereof), I’d be surprised if anything changed too dramatically. We’ll talk more about possible changes in a future post.

We’ll be back next week with another MACRA Monday talking about who will be impacted by MACRA and whether your practice should be worried about participating in the APM or MIPS program.

What’s the Impact of MACRA on Small Practices?

Posted on July 22, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently had a chance to sit down and chat with Tom Giannulli, MD, Chief Medical Officer of Kareo and Michael Sherling, MD, MBA, Chief Medical Officer and Co-founder of Modernizing Medicine, to talk about the impact of the MACRA legislation on small practices. Both of these CMOs at EHR vendors rode the meaningful use wave and now they’re preparing to ride the new MACRA wave as well. So, they were the perfect people to talk about the impact of MACRA on small practices and how a small practice should prepare themselves for the new MACRA legislation. If you’re a small practice that’s wondering about MACRA (or doesn’t even know what it is), then take the time to watch the video below to see what it means for small practices.

After our formal interviews, we always like to hold what we call the “after party.” We never know how it’s going to go. Sometimes people join in and offer their insights and ask questions and sometimes they don’t. In this case, we continued our conversation about the MACRA and small practices, but we also talked about the impact that legislation like MACRA has on an EHR vendors development lifecycle. You can learn more about MACRA in the video below:

This post was a great way to wrap up the week and also for us to announce a new blog post series we’re starting on Monday called MACRA Monday. Long time readers may remember the Meaningful Use Monday series of blog posts we did every Monday for a few years. This will be similar as we dive into the MACRA legislation and help small medical practices understand the details of what’s coming in MACRA. Watch for that on Monday!

Team Training Can Produce Great Results

Posted on July 21, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new study suggests that team training of healthcare staffers can cut patient mortality and also reduce medical errors. The study, which was conducted by multiple universities and two federal agencies, also found that such training improved staff members’ learning skills and use of such skills, as well as boosting financial outcomes, clinical performance and patient satisfaction.

Participants in the research program included Rice University, the Johns Hopkins University School of Medicine, the University of Central Florida, the U.S. Department of Defense and the Michael E. DeBakey VA Medical Center. The researchers conducted a meta-analysis of 129 prior studies, which looked at programs designed to improve team-based knowledge, skills, attitudes and problem-solving interactions, as well as developing coordination, cooperation, communication and leadership skills.

To conduct their analysis, researchers looked at the impact of team training programs among 23,018 participants. The studies being analyzed looked at how team training affected quality of care, customer service, patient satisfaction and other relevant variables. Participants in the team trainings included clinicians, allied health staffers, support staffers and healthcare students. The trainings were conducted at facilities ranging from small clinics to large hospitals in the U.S. and abroad.

Researchers found that team training can reduce patient mortality by 15%, and reduce medical errors by 19%. The training program also boosted employees’ learning of new skills by 31% and on-the-job use of such skills by 25%. In addition, the training improved financial outcomes of healthcare organizations by 15%. And team training was associated with a 34% improvement in clinical performance and 15% growth in patient satisfaction, researchers said.

While this study didn’t address health IT teams, it’s easy to see how such cross-disciplinary efforts might help IT staffers succeed.

As Rick Krohn of HealthDataManagement aptly puts it, health IT teams often cope with “a spaghetti bowl of boutique applications, systems and external linkages,” which creates major stresses and leaves little time for outreach. In other words, as things stand, keeping rank and file HIT staffers from burning out is a challenge – and keeping them aware of end user needs is a daunting task.

But if health IT managers have at least sporadic team meetings with outside departments that depend on them – including clinical, financial and operational units – a big uptick in learning, sharing and coordination may be possible. As the study underscores, people have to be taught how to work with their partners in the organization, no matter how professional everyone is. Fostering a cooperative exchange between health IT front-liners and users can make that happen.

Artificial Intelligence Can Improve Healthcare

Posted on July 20, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

In recent times, there has been a lot of discussion of artificial intelligence in public forums, some generated by thought leaders like Bill Gates and Stephen Hawking. Late last year Hawking actually argued that artificial intelligence “could spell the end of the human race.”

But most scientists and researchers don’t seem to be as worried as Gates and Hawking. They contend that while machines and software may do an increasingly better job of imitating human intelligence, there’s no foreseeable way in which they could become a self-conscious threat to humanity.

In fact, it seems far more likely that AI will work to serve human needs, including healthcare improvement. Here’s five examples of how AI could help bring us smarter medicine (courtesy of Fast Company):

  1. Diagnosing disease:

Want to improve diagnostic accuracy? Companies like Enlitic may help. Enlitic is studying massive numbers of medical images to help radiologists pick up small details like tiny fractures and tumors.

  1. Medication management

Here’s a twist on traditional med management strategies. The AiCure app is leveraging a smartphone webcam, in tandem with AI technology, to learn whether patients are adhering to their prescription regimen.

  1. Virtual clinicians

Though it may sound daring, a few healthcare leaders are considering giving no-humans-involved health advice a try. Some are turning to startup Sense.ly, which offers a virtual nurse, Molly. The Sense.ly interface uses machine learning to help care for chronically-ill patients between doctor’s visits.

  1. Drug creation:

AI may soon speed up the development of pharmaceutical drugs. Vendors in this field include Atomwise, whose technology leverages supercomputers to dig up therapies for database of molecular structures, and Berg Health, which studies data on why some people survive diseases.

  1. Precision medicine:

Working as part of a broader effort seeking targeted diagnoses and treatments for individuals, startup Deep Genomics is wrangling huge data sets of genetic information in an effort to find mutations and linkages to disease.

In addition to all of these clinically-oriented efforts, which seem quite promising in and of themselves, it seems clear that there are endless ways in which computing firepower, big data and AI could come together to help healthcare business operations.

Just to name the first applications that popped into my head, consider the impact AI could have on patient scheduling, particularly in high-volume hostile environments. What about using such technology to do a better job of predicting what approaches work best for collecting patient balances, and even to execute those efforts is sophisticated way?

And of course, there are countless other ways in which AI could help providers leverage clinical data in real time. Sure, EMR vendors are already rolling out technology attempting to help hospitals target emergent conditions (such as sepsis), but what if AI logic could go beyond condition-specific modules to proactively predicting a much broader range of problems?

The truth is, I don’t claim to have a specific expertise in AI, so my guesses on what applications makes sense are no better than any other observer’s. On the other hand, though, if anyone reading this has cool stories to tell about what they’re doing with AI technology I’d love to hear them.

Study: Doctors Made More Note-Taking Errors With EHRs Than Paper

Posted on July 19, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new study appearing in the Journal of the American Medical Informatics Association has concluded that a sample group of physicians made more data entry errors with a new EHR than in comparable paper records, according to a HealthcareITNews item.

Researchers studied progress notes created at a Michigan hospital, Beaumont Hospital of Royal Oak, Michigan, between August 2011 and July 2013. They looked at 500 notes created during that period, some of which were prepared before the EHR implementation in 2012 and some after. The charts contained five specific diagnoses which always include physical findings, including permanent atrial fibrillation, aortic stenosis, intubation, lower limb amputation and cerebrovascular accident with hemiparesis.

Upon analysis, they found that rates of inaccurate documentation were 24.4% with the EHR, versus 4.4% with paper records. Residents had fewer inaccuracies (5.3% vs. 17.3%) and omissions (16.8% vs. 33.9%) than attending physicians.

While this is no reason to throw the EHR baby out with the bathwater – after all, the physicians in question were learning a system for the first time – it’s still a troubling set of statistics. They are even more troubling given that EHR documentation errors can sometimes create patient safety problems of their own, especially in fast-moving care settings like the emergency department.

“There are new categories of patient safety errors” taking place in EDs that didn’t exist before EHR use became commonplace, according to Raj Ratwani, scientific director for MedStar Health’s National Center for Human Factors in Healthcare in Washington, D.C., who spoke with Kaiser Health News. For example, EHRs that only allow doctors to edit records for one patient at a time can make it harder to track ED patients, according to MedStar physician Zach Hettinger.

Without a doubt, the healthcare industry can’t afford to have its IT infrastructure creating new categories of safety errors or even making mistake-ridden documentation more common. Not only does this defeat the key goals for putting EHRs in place (improving care quality and efficiency), it could lead to a net increase in safety problems.

But as peanut-gallery observers like myself have been shouting for ages, the answer to the problem is fairly straightforward. EHR user interaction design has to be improved dramatically, and soon. This isn’t exactly a secret, but it seems that the issue is still treated largely as an academic discussion rather than one of immediate practical importance for providers.

I’m not sure why we haven’t made more progress on the user experience front in EHR design – or rather, which of the reasons can actually be addressed in our lifetime – but something’s gotta give.

Physicians Still Struggle To Find EHR Value

Posted on July 18, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new study by Physicians Practice magazine suggests that medical groups still aren’t getting what they want out of their EHRs, with nearly one-fifth reporting that they’re still struggling with an EHR-related drop in productivity and others still trying to optimize their system.

Physicians Practice surveyed 1,568 physicians, advanced practice providers across the U.S. as part of its 2016 Technology Survey. Nearly a third of respondents (31.9%) were in solo practice, and 34% in 2 to 5 physician practices, with percentages largely dropping as practice sizes grew larger.

Specialties represented included pediatrics (17.5%), family medicine (16.2%), OB/GYN (15.2%), psychiatry (12%), internal medicine (10.6%), surgery (2.9%), general practice (2.7%) and “other” at 22.9% (led by ophthalmology). As to business models, 63.3% of practices were independently-owned, 27.9% were part of an integrated delivery network and the remaining 8.8% were “other,” led by federally-qualified health centers.

Here’s some interesting data points from the survey, with my take:

  • Almost 40% of EHR users are struggling to get value out of their system: When asked what their most pressing technology problem was, 20.3% said it was optimizing use of their EHR, 18.9% a drop in productivity due to their EHR, and 12.9% a lack of interoperability between EHRs. Both EHR implementation and costs to implement and use technologies came in at 8%.
  • EHR rollouts are maturing, but many practices are lagging: About 59% of respondents had a fully-implemented EHR in place, with 14.5% using a system provided by a hospital or corporate parent. But 16.8% didn’t have an EHR, and 9.5% had selected an EHR (or a corporate parent had done so for them) but hadn’t fully implemented or optimized yet.
  • Many practices that skip EHRs don’t think they’re worth the trouble and expense: Almost 41% of respondents who don’t have a system in place said that they don’t believe it would improve patient care, 24.4% said that such systems are too expensive. A small but meaningful subset of the non-users (6.6%) said they’d “heard too many horror stories.”
  • Medical group EHR implementations are fairly slow, with more than one-quarter limping on for over a year: More than a third (37.2%) of practices reported that full implementation and training took up to six months, 21.2% said it took more than six months and less than a year, 12.8% said more than a year but less than 18 months, and 15.7% at more than 18 months.
  • Most practices haven’t seen a penny of return on their EHR investment: While just about one-quarter of respondents (25.7%) reported that they’d gotten ROI from their system, almost three-quarters (74.3%) said they had not.
  • Loyalty to EHR vendors is lukewarm at best: When asked how they felt about their EHR vendor, 39.7% said they were satisfied and would recommend them, but felt other vendors would be just as good. Just over 16% said they were very satisfied. Meanwhile, more than 17% were either dissatisfied and regretted their purchase or ready to switch to another system.
  • The big EHR switchout isn’t just for hospitals: While 62.1% of respondents said that the EHR they had in place was their first, 27.1% were on their second system, and 10.8% their third or more.

If you want to learn more, I recommend the report highly (click here to get it). But it doesn’t take a weatherman to see which way these winds are blowing. Clearly, many practices still need a hand in getting something worthwhile from their EHR, and I hope they get it.