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MACRA Final Rule – MACRA Monday

Posted on October 31, 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.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

On Friday, November 4, 2016 at 3:00 PM ET (Noon PT) Healthcare Scene be hosting a live video interview with three MACRA experts. Many of you might have seen our earlier interview with these three experts where we made predictions on the MACRA final rule and also talked about the challenges practices will face with MACRA. Now that the MACRA final rule has been published, we’re going to do a follow up interview to see where we were right and wrong and also talk about changes that came out in the MACRA final rule.

The great part is that you can join my conversation with this panel of experts live and even add your own comments to the discussion or ask them questions. All you need to do to watch live is visit this blog post on Friday, November 4, 2016 at 3:00 PM ET (Noon PT) and watch the video embed at the bottom of this post or you can watch on YouTube directly. The conversation will be recorded as well and available on this post after the interview.

Here are a few details about our panelists:

2016-november-macra-final-rule

We hope you’ll join us live or enjoy the recorded version of our conversation. Understanding MACRA and evaluating how your practice should approach MACRA is going to be crucial to the success of your organization. Join us so you can learn the latest insights and perspectives on the MACRA final rule.


(To Ask Questions, visit the YouTube page)

If you’d like to see the archives of Healthcare Scene’s past interviews, you can find and subscribe to all of Healthcare Scene’s interviews on YouTube.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

Low – A Flo Rida Clinic Parody by ZDoggMD

Posted on October 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.

It’s time for a Fun Friday blog post. We don’t do it every Friday, but it’s fun to do on occasion. Our most popular Fun Fridays are whenever we feature the slightly funnier than placebo ZDoggMD. If you haven’t seen his videos, then you’re missing out. There are a ton of incredible ones. Today we’re going to highlight his latest parody of Flo Rida’s song Low. About a third the way into the video ZDoggMD really cranks it up and brings so many laughs.

I love how ZDoggMD is incorporating more and more doctors, nurses, and patients into his videos. I’m told they fly out to Las Vegas to take part in the tapings. Pretty cool. In the above video I also love the appearance of Tony Hsieh, CEO of Zappos. When he flashes the snapchat screen that says “I’m not sure what’s going on” it was the perfectly captured Tony Hsieh moment.

It’s always nice to bring a little humor to the challenges we face in healthcare.

Talking Health Transformation at the First Ever #ATAChat

Posted on October 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.

telemedicine-twitter-chat-ata

I’m excited to be the first host of the newly launched #ATAChat organized by the American Academy of Telemedicine. I was lucky to run into Nathaniel Lacktman, an expert legal resource on telehealth, at a recent conference and from that meeting it led to the opportunity for Healthcare Scene to host the first American Telemedicine Association Twitter chat.

For the first Twitter chat, we left the conversation pretty open ended to cover a variety of innovations and transformations happening in healthcare and telehealth. I imagine future ATA Chats will dive deeper into the challenges of telehealth and healthcare transformation. If you have an interest in this area, come and share your insights in what you see happening and things you’re working on. Plus, you’ll be able to learn and connect with a wide variety of other healthcare innovators.

To join the #ATAChat on Twitter, just search for the #ATAChat hashtag on Wednesday, November 9, 2016 at 2 PM ET (11 AM PT). We’ll post the following 5 questions over the hour long chat:

  1. What role should technology play in healthcare and innovation?
  2. What are some of the most exciting ways providers are using virtual care to deliver services?
  3. How is telehealth changing the role of healthcare professionals’ “human touch”, and is it a good thing for patients?
  4. What are the biggest barriers to healthcare innovation and what solutions can we use to navigate them?
  5. What are the best opportunities and areas of unmet need for telehealth and virtual care in the next 3 years?

If you have an insight, question, or comment, just add #ATAChat to your tweets and everyone that’s following along will see it. We hope to make it a really interactive discussion. Plus, it’s always fun to meet new and interesting people that you can connect with on social media.

I look forward to seeing everyone at the #ACAChat on Wed November 9th!

Physician Calls For Widespread Patient Data Ownership

Posted on October 26, 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.

At present, patients anywhere in the United States are entitled to access their patient records, but the records are typically controlled by providers. New Hampshire is the only state which provides citizens with legal ownership of the health information, notes Eric Topol, MD.

“That’s completely wrong. That has to get fixed,” said Topol, who spoke at the MedCity ENGAGE show last week. “It should be your data.”  In fact, he calls patient data ownership “a civil right that’s yet to be granted.”

Patient data ownership rules vary across the U.S. In many states, including Washington, Idaho, North Dakota, Minnesota, Wisconsin, Michigan, New York, Maine, Pennsylvania, and Nevada, there was no law in place as of mid-2015 which specified whether patients are providers owned or had property rights medical records. But in a large number of additional states, including Oregon, California, Texas, Georgia and New Mexico, state laws specifically state that the hospital or physician owns the medical record.

Long before EMRs went into wide use, ownership of medical records would occasionally come into dispute, such as when a practice went out of business or a hospital was acquired. The historic lack of clear case law governing such transactions would occasionally lead to major legal controversies during such transitions.

Today, the stakes are even higher, contends Topol, who serves as director of the Scripps Translational Science Institute at San Diego-based Scripps Health. To realize the benefits of “individualized medicine” – Topol’s term for “precision medicine” — patients will have to control their health data, he said.

“We are going to be leaving population medicine – where it’s one size fits all — in favor of individualized medicine,” Topol told the audience. With individualized medicine, patients drive their own care, he said.

The current centralized model of health data ownership actually poses a risk to patients, Topol argues, given the ripe, financially-attractive lure that big databases pose. “We need to decentralize this data because the more it’s amassed, the more it’s going to be hacked,” he contends.

So what of Topol’s vision for “individualized medicine”? Well, here’s how I see it. Topol’s comments are interesting, but it seems to me that there’s an inherent contradiction between one half of his arguments and the other.

If by talking about individualized medicine, he’s referring to what is otherwise known as precision medicine, I’m not sure how we can pull it off without building big databases. After all, you don’t gain broad understandings of how, say, a cancer drug works without crunching numbers on thousands or millions of cases. So while giving consumers more power over the medical records makes sense, I don’t see how we could fail to aggregate them to some degree at least.

On the other hand, however, it does seem absurd to me that patients should ever lack the right to retrieve all of the records from the custody of a provider, particularly if the patient alleges malpractice or some form of malfeasance. If we want patients to engage with their health, owning the documentation on the care they received strikes me as an absolutely necessary first step.

Creating Healthcare Interoperability Bundles

Posted on October 25, 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.

At this point in the evolution of healthcare data, you’d think it would be easy to at least define interoperability, even if we can’t make it happen. But the truth is that despite the critical importance of the term, we still aren’t as clear as we should be on how to define it. In fact, the range of possible solutions that can be called “interoperable” is all over the map.

For example, a TechTarget site defines interoperability as “the ability of a system or a product to work with other systems or products without special effort on the part of the customer.” When defined down to its most basic elements, even passive methods of pushing data from one to another count is interoperability, even if that data doesn’t get used in clinical care.

Meanwhile, an analysis by research firm KLAS breaks interoperability down into four levels of usefulness, ranked from information being available, to providers having the ability to locate records, to the availability of clinical view to this data having an impact on patient care.

According to a recent survey by the firm, 20% of respondents had access to patient information, 13% could easily locate the data, 8% could access the data via a clinical view and just 6% had interoperable data in hand that could impact patient care.

Clearly, there’s a big gap between these two definitions, and that’s a problem. Why? Because the way we define baseline interoperability will have concrete consequences on how data is organized, transmitted and stored. So I’d argue that until we have a better idea of what true, full interoperability looks like, maybe we should map out interoperability “bundles” that suit a given clinical situation.

A Variety of Interoperabilities

For example, if you’re an ACO addressing population health issues, it would make sense to define a specific level of interoperability needed to support patient self-management and behavioral change. And that would include not only sharing between EMR databases, but also remote monitoring information and even fitness tracking data. After all, there is little value to trying to, say, address chronic health concerns without addressing some data collected outside of clinic or hospital.

On the other hand, when caring for a nursing home-bound patient, coordination of care across hospitals, rehab centers, nurses, pharmacists and other caregivers is vital. So full-fledged interoperability in this setting must be effective horizontally, i.e. between institutions. Without a richly-detailed history of care, it can be quite difficult to help a dependent patient with a low level of physical or mental functioning effectively. (For more background on nursing home data sharing click here.)

Then, consider the case of a healthy married couple with two healthy children. Getting together the right data on these patients may simply be a matter of seeing to it that urgent care visit data is shared with a primary care physician, and that the occasional specialist is looped in as needed. To serve this population, in other words, you don’t need too many bells and whistles interoperability-wise.

Of course, it would be great if we could throw the floodgates open and share data with everyone everywhere the way, say, cellular networks do already. But given that such in event won’t happen anytime in the near future, it probably makes sense to limit our expectations and build some data sharing models that work today.

MACRA Fallout and Physician Burnout – MACRA Monday

Posted on October 24, 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.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

I’ve been traveling the past week and still haven’t had time to fully process the MACRA final rule. In fact, it might take me a few weeks to really get things together around what’s in the final rule. It’s better that I take my time and make sure I provide you accurate information than to post early and perpetuate bad information. So, I appreciate your patience.

In the mean time, we’ll still continue on with MACRA Monday talking about some of the impact of the MACRA rule and interesting comments on what’s happening with MACRA. Today I wanted to highlight the vitriol I’ve seen online by many physicians towards MACRA. It’s been pretty ugly.

If I’m being fair to MACRA, most of the hatred has to do with the wave of government regulations and the changes happening across all of healthcare and not just MACRA. In many cases, it just seems that MACRA is the straw that broke the proverbial camel’s back. However, I’ve seen first-hand from more physicians than I can count, a real anger towards MACRA.

I do temper these experiences with the fact that so many physicians barely even know that MACRA exits. That’s not true for the ones complaining on social media, but it definitely feels like even many of those doctors barely realize what is in MACRA (with a few notable exceptions). Instead of specific complaints, they are mostly general complaints about government regulation.

Sadly, I think it kind of reminds me of my experience talking with my 12-year-old son. He’s at the stage of life where no matter what I say as a father he wants to say the opposite. I can literally say something nice to him like “You’re smart” and without even thinking about what I said he’ll knee jerk react “No, I’m not.” It makes no sense and is absolutely frustrating as a parent.

My guess is this is how the people at CMS feel when they hear doctors talking about MACRA. If MACRA was just free government money with no work, my gut is that many doctors would say it’s awful without even looking at the details. Doctors are so burnt out on government regulation that they denounce it without as much as a second thought.

Given some of the past track record, doctors have good reason to react the way they do. Can you point to very many places where meaningful use made a doctor’s life better? There are quite a few general EHR benefits, but very few specific meaningful use benefits. In fact, you can make a strong case that meaningful use added a lot of overhead and almost no value to patients or doctors. Given that, should we be surprised that doctors are afraid of more government regulation?

I’m not surprised, but with that said I also don’t think that MACRA will be the disaster that many make it out to be. In fact, I think it’s an extension of business as usual. This is particularly true in the first year of MACRA where almost no one will get penalized thanks to the MACRA Pick Your Pace options. We’ll see if that creates a pileup in future years.

I’m torn since I think we’re entering one of the most exciting times to be in healthcare. The technologies that are hitting healthcare are quite extraordinary. What we’ll be able to do with the data we’re collecting and will be able to collect in healthcare is going to surprise us all. However, on the other hand regulations are creating a burden on providers that is causing what could be irreparable harm.

Reminds me of that famous line, “It was the best of times, it was the worst of times.”

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

EHR Conversion is About to Get A Lot More Difficult

Posted on October 21, 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’ve been talking to a lot of companies that are getting involved in the EHR conversion space. It makes sense that so many are interested in EHR conversion. It’s an extremely important task and a lot of organizations are going to need this service. While it’s great to think that you can limp along legacy EHR and health IT systems, it just doesn’t become practical when you look at what it means long term to your organization from both a cost and quality of care perspective.

In one of my recent conversations, an EHR conversion expert commented that EHR conversions are about to get a lot more difficult. His argument was that most past EHR conversions were from client server EHR systems that were hosted on a server in the doctor’s office. While those aren’t easy by any means, at least the person doing the conversion had access to the EHR data since it was on a server that you were hosting. It’s not going to be as easy to get to the data with these cloud hosted EHR platforms (or so he argues).

He’s right that a cloud hosted EHR is generally harder to get access to the data in an EHR conversion. In fact, this is why it’s so extremely important that when you select a cloud based EHR you include the right language in your contract when it comes to ownership and access to your data. If you don’t, you could be in real trouble.

It will be interesting to see how this evolves. As more healthcare organizations move to the cloud, will some wise cloud EHR vendors make it easy for healthcare organizations to export all their EHR data from the cloud? Will healthcare organizations demand this service? Will we see vendor neutral archives of EHR data become popular (especially with cloud hosted EHR)?

My fear is that most organizations aren’t that forward thinking. They just can’t imagine ever leaving their current EHR. Given the number of mergers and acquisitions that have happened and will happen in both the EHR world and between healthcare organizations, it would be wise to start thinking about these things earlier rather than later when you won’t have as many options available.

If you want more data on the EHR conversion and legacy EHR system world, be sure to check out the excellent Tackling EHR and EMR Transition series. It’s a great series of posts, infographics, and whitepapers on this important topic. A topic that is only going to become more important over time. Is your organization ready?

Hospitals and General Grant Have a Lot in Common

Posted on October 20, 2016 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

A few weeks ago, I was having a bad dream. Everything was turning black. It was hard to breath and moving was equally labored. It wasn’t a dream. I woke up and found myself working hard to inhale. Getting out of bed took determination.

I managed to get to our hallway and call my wife. She called 911 and DC’s paramedics soon had me on my way to Medstar’s Washington Hospital Center’s ER. They stabilized me and soon determined I wasn’t having a heart attack, but a heart block. That is, the nerve bundles that told my heart when to contract weren’t on the job.

A cardiology consult sent me to the Center’s Cardiac Electrophysiology Suite (EP Clinic), which specializes in arrhythmias. They ran an ECG, took a quick history and determined that the block wasn’t due to any meds, Lime disease, etc. Determining I needed a pacemaker, they made me next in line for the procedure.

Afterwards, my next stop was the cardiac surgery floor. Up till then, my care was by closely functioning teams. After that, while I certainly wasn’t neglected, it was clear I went from an acute problem to the mundane. And with that change in status, the hospital system’s attention to detail deteriorated.

This decline led me to a simple realization. Hospitals, at least in my experience, are much like Ulysses Grant: stalwart in crisis, but hard pressed with the mundane. That is, the more critical matters became in the Civil War, the calmer and more determined was Grant. As President, however, the mundane dogged him and defied his grasp.

Here’re the muffed, mundane things I encountered in my one overnight stay:

  • Meds. I take six meds, none exotic. Despite my wife’s and my efforts, the Center’s system could not get their names or dosages straight. Compounding that, I was told not to take my own because the hospital would supply them. It couldn’t either find all of them or get straight when I took them. I took my own.
  • Food. I’d not eaten when I came in, which was good for the procedure. After it, the EP Clinic fed me a sandwich and put in food orders. Those orders quickly turned into Nothing by Mouth, which stubbornly remained despite nurses’ efforts to alter it. Lunch finally showed up, late, as I was leaving.
  • Alarm Fatigue. At three AM, I needed help doing something trivial, but necessary. I pressed the signaling button and a nurse answered who could not hear me due to a bad mike. She turned off the alert. I clicked it on again. Apparently, the nurses have to deal with false signals and have learned to ignore them. After several rounds, I stumbled to the Nurses’ Station and got help.
  • Labs. While working up my history, the EP Clinic took blood and sent for several tests. Most came back quickly, but a few headed for parts unknown. No one could find out what happened to them.
  • Discharge. The EP Clinic gave me a set of instructions. A nurse practitioner came by and gave me a somewhat different version. When we got home, my wife called the EP Clinic about the conflict and got a third version.
  • EHR. The Hospital Center is Washington’s largest hospital. My PCP is at the George Washington University’s Medical Faculty Associates. Each is highly visible and well regarded. They have several relationships. The Center was supposed to send GW my discharge data, via FAX, to my PCP. It didn’t. I scanned them in and emailed my PCP.

In last five years, I’ve had similar experiences in two other hospitals. They do great jobs dealing with immediate and pressing problems, but their systems are often asleep doing the routine.

I’ve found two major issues at work:

  • Incomplete HIT. While these hospitals have implemented EHRs, they’ve left many functions big and small on paper or on isolated devices. This creates a hybrid system with undefined or poorly defined workflows. There simply isn’t a fully functional system, rather there are several of them. This means that when the hospital staff wants to find something, first they’ll look in a computer. Failing that, they’ll scour clipboards for the elusive fact. It’s like they have a car with a five speed transmission, but only first and second gear are automatic.
  • Isolated Actors. Outside critical functions, individuals carry out tasks not teams. That is, they often act in isolation from those before or after them. This means issues are looked at only from one perspective at a time. This sets the stage for mistakes, omissions and misunderstandings. A shared task list, a common EHR function, could end this isolation.

The Hospital Center is deservedly a well regarded. It’s heart practice is its special point of pride. However, its failure to fully implement HIE is ironic. That’s because Medstar’s National Center for Human Factors in Healthcare isn’t far from the Hospital.

The problems I encountered aren’t critical, but they are troublesome and can easily lead to serious even life endangering problems. Most egregious is failure to fully implement HIT. This creates a confusing, poorly coordinated system, which may be worse than no HIT at all.

Consider The Portable EMR

Posted on October 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.

The other day I was reading the Huffington Post, and was surprised to stumble across a rather interesting article promoting the benefits of a “portable” EMR. Now, for HIT fans like ourselves, the word portability implies having data travel from one provider directly to another in a usable manner. But author David Black, who describes himself as a “software guy” and Technology Partner at Oak HC/FT, has something different in mind.

For Black, the best way to share healthcare data would be if the patient carried it around from place to place and updated it as they travel from provider to provider. To be more specific, the portable EMR is an app with all of the patient’s healthcare data and history stored in it. The app would serve the purpose Microsoft Outlook does for email, with the data stored and backed up in the cloud, available to sync to any device.

As Brown sees it, not only would this be a way to keep data at patients’ fingertips, it would be a better way to control access to PHI as well. As he notes, many apps ask permission to access data such as email contacts. In this case, the app would ask permission before sharing the data with medical professionals. None of the data would be “locked up” in an EMR, he says.

Now, while I’m intrigued by this idea, I can see several problems that would result from wide adoption of this approach, including the following:

* Safety and security of the data stored in the cloud:  I’m no legal expert, but from what I’ve read about the healthcare cloud, any cloud vendor with which a provider works must be a full Business Associate under HIPAA, and meet the data security standards involved. I doubt many cloud services chosen by a consumer are in compliance, and that needs to be resolved before these become too popular.

* Securing of the consumers’ data:  Ok, let’s say that the cloud-based backup arrangements were kosher. Live ePHI is still resident (and probably quite hackable) on the consumer device which contains the EMR portability app. How can consumers protect it adequately, and if they don’t what happens to systems within the provider organization that access it?

* Carrying the device:  Even if the consumer data in the portability app is secure both in the cloud and on the device, that device still has to travel with the patient. No one wants to carry a laptop everywhere, smartphones and tablets have usability issues and other devices come with their own questions. Also, if the patient’s phone or laptop gets smashed in a car wreck, but providers need current health data to treat them, where do they get it?

Despite these complaints, I do see the benefits of Brown’s approach. Putting portability into the patients’ hands has not only accessibility benefits, but also stands to boost patient engagement. (And in fact, I know of at least one company – full disclosure, a client – that’s actually doing something along these lines.) But the model that Brown is proposing has many challenges to address.

News Flash: Physicians Still Very Dissatisfied With EMRs

Posted on October 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.

Anyone who reads this blog knows that many physicians still aren’t convinced that the big industry-wide EMR rollout was a good idea. But nonetheless, I was still surprised to learn — as you might be as well — that in the aggregate, physicians thoroughly dislike pretty much all of the ambulatory EMRs commonly used in medical practices today.

This conclusion, along with several other interesting factoids, comes from a new report from healthcare research firm peer60. The report is based on a survey from the firm conducted in August of this year, reaching out to 1,053 doctors in various specialties.

Generally speaking, the peer60 study found that EMR market for acute care facilities is consolidating quickly, and that Epic continues to add market share in the ambulatory EMR market (Although, it’s possible that’s also survey bias).  In fact, 50% of respondents reported using an Epic system, followed by 21% Cerner, 9% Allscripts and 4% the military EMR VistA.  Not surprisingly, respondents reporting Epic use accounted for 55% of hospitals with 751+ beds, but less predictably, a full 59% of hospitals of up to 300 beds were Epic shops as well. (For an alternate look at acute care EMR market share, check out the stats on systems with the highest number of certified users.)

When it came to which EMR the physician used in their own practice, however, the market looks a lot tighter. While 18% of respondents said they used Epic, 7% reported using Allscripts, 6% eClinicalWorks, 5% Cerner, 4% athenahealth, e-MDs and NextGen, 3% Greenway and Practice Fusion and 2% GE Healthcare. Clearly, have remained open to a far greater set of choices than hospitals. And that competition is likely to remain robust, as few practices seem to be willing to change to competitor systems — in fact, only 9% said they were interested in switching at present.

To me, where the report got particularly interesting was when peer60 offered data on the “net promoter scores” for some of the top vendors. The net promoter score method it uses is simple: it subtracts the percent of physicians who wouldn’t recommend an EMR from the percent who would recommend that EMR to get a number from 100 to -100. And obviously, if lots of physicians reported that they wouldn’t recommend a product the NPS fell into the negative.

While the report declines to name which NPS is associated with which vendor, it’s clear that virtually none have anything to write home about here. All but one of the NPS ratings were below zero, and one was rated at a nasty -73. The best NPS among the ambulatory care vendors was a 5, which as I read it suggests that either physicians feel they can tolerate it or simply believe the rest of the crop of competitors are even worse.

Clearly, something is out of order across the entire ambulatory EMR industry if a study like this — which drew on a fairly large number of respondents cutting across most hospital sizes and specialties — suggests that doctors are so unhappy with what they have. According to the report, the biggest physician frustrations are poor EMR usability and a lack of desired functionality, so what are we waiting for? Let’s get this right! The EMR revolution will never bear fruit if so many doctors are so frustrated with the tools they have.