Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

Safety Issues Remain Long After EMR Rollout

Posted on June 24, 2014 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 @annezieger on Twitter.

The following is a bit depressing, but shouldn’t come as a surprise. A new study published in the Journal of the American Medical Informatics Association has concluded that patient safety issues relate to EMR rollouts continue long after the EMR has been implemented, according to a report in iHealthBeat.

Now, it’s worth noting that the study focused solely on the Veterans Health Administration’s EMR, which doubtless has quirks of its own. That being said, the analysis is worth a look.

To do the study, researchers used the Veterans Health Administration’s Informatics Patient Safety Office, which has tracked EMR safety issues since the VA’s EMR was implemented in 1999.  Researchers chose 100 closed patient safety investigations related to the EMR that took place between August 2009 and May 2013, which covered 344 incidents.

Researchers analyzed not only safety problems related to EMR technology, but also human operational factors such as workflow demands, organizational guidelines and user behavior, according to a BMJ release.

After reviewing the data, researchers found that 74 events related to safety problems with EMR technology, including false alarms, computer glitches and system failures. They also discovered problems with “hidden dependencies,” situation which a change in one part of the EMR system inadvertently changed important aspects in another part of the system.

The data also suggested that 25 other events were related to the unsafe use of technology, including mistakes in interpreting screens or human input errors.

All told, 70% of the investigations had found at least two reasons for each problem.

Commonly found safety issues included data transmission between different parts of the EMR system, problems related to software upgrades and EMR information display issues (the most commonly identified  problem), iHealthBeat noted.

After digging into this data, researchers recommended that healthcare organizations should build “a robust infrastructure to monitor and learn from” EMRs, because EMR-related safety concerns have complicated social and technical origins. They stressed that this infrastructure is valuable not only for providers with newly installed EMRs, but also for those with EMRs said that in place for a while, as both convey significant safety concerns.

They concede, however, that building such an infrastructure could prove quite difficult at this time, with organizations struggling with meaningful use compliance and the transition from ICD-9 to ICD-10.

However, the takeaway from this is that providers probably need to put safety monitoring — for both human and technical factors — closer to the top of their list of concerns. It stands to reason that both newly-installed and mature EMR implementations should face points of failure such as those described in the study, and they should not be ignored. (In the meantime, here’s one research effort going on which might be worth exploring.)

More Details From Study: Health IT Could Cut Demand For Physicians

Posted on December 11, 2013 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 @annezieger on Twitter.

Earlier, we wrote up the following study, which strongly suggests that health IT can boost physician productivity. But we didn’t include some of the details you’ll see below — and we thought they were important enough for a follow-up.

Much of the talk about health IT in physicians’ offices addresses the struggles doctors face when adopting new technologies, and the effort it takes to get productivity back to normal levels. But this study takes things a step further, asserting that if health IT was fully and widely implemented, it could reduce demand for physicians substantially.

The study, which originally appeared in Health Affairs, concluded that if health IT were fully implemented in 30 percent of community-based physicians’ offices, efficiency improvements would cut demand for physicians by 4 percent to 9 percent. What’s more, using health IT to delegate work to midlevel practitioners and from specialists to primary care docs could reduce demand for physicians by 6 percent to 12 percent, according to a story in Information Week.

Meanwhile, growing the amount of IT-enabled remote and asynchronous care could cut the volume of overall care that physicians provide could  have a big impact as well. Remote care could cut the percentage of care that physicians provide by 2 percent to 5 percent, and asynchronous care by 4 percent to  7 percent, Information Week reports.

And that isn’t all. If 70 percent of office-based docs adopted comprehensive IT support, including interoperable EMRs, clinical decision support, provider order entry and patient Web portals with secure messaging, the drop in demand for physician services would be twice as large, the Health Affairs study concluded.

That being said, the comprehensive use of health IT by even 30 percent of office-based doctors is at least five years and maybe as much as 15 years away, according to one of the study’s authors, Jonathan Weiner, professor of health policy and management at Johns Hopkins’ Bloomberg School of Public Health.

23andMe Saga Doesn’t Bode Well for EMR Genetics Integration

Posted on December 5, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

I wrote about the direct-to-consumer genetic testing company 23andMe back in mid-October, posing the idea that genetic information provided by the patient could only serve to enrich EMR data. I noted, “Genetic testing seems to be about empowering patients to take more proactive roles in managing their health today in an effort to prevent what might happen to their health in the future. It would make sense to share these test results with providers who can aid in that journey.”

Two readers chimed in. One noted that, “No [current] EMR can run genetic risk models or use genetic clinical decision support, [and ] [n]one of these fit into Meaningful Use, so it will be years until the EMR have the capability needed to use genomics.”

Another pointed out that, “the price point on 23andMe was all I was waiting for, and I have my gene sequence already. Yes, there are some risks, but that argument falls into the same category as any technology or innovation – it can be used for good or bad. The value this information brings far exceeds the downsides, and is now an essential part of the data feed to my personal healthcare.”

That last comment is especially interesting in light of the well-publicized tiff going on between 23andMe and the FDA. I won’t waste your time attempting to summarize the string of events that have led 23andMe to stop marketing its products, as well as a class action lawsuit and an official petition to overrule the FDA’s decision. Instead, I’ve compiled a few articles that detail the saga as it has unfolded.

Why Genetic Testing Could Endanger Your Health / ChicagoTribune.com

The FDA Drops an Anvil on 23andMe – Now What? / Stanford.edu

Founder of 23andMe speaks on FDA concerns / USAToday.com

Can 23andMe Survive the FDA? / TheVerge.com

Class Action Lawsuit Filed Against 23andMe / Forbes.com

23andMe Shuts down health-related genetics testing to work with FDA / Gigaom.com (Updated 12/6)

As far as the connection between genetic information gathered via commercial means by patients being incorporated into EMRs, it doesn’t look like it will happen easily anytime soon. It seems there are bigger debates brewing over the scope of the FDA’s regulatory power over companies like 23andMe, what the definition of a medical device should be, and the value consumers find in these services. Do they really lead to unnecessary medical tests and procedures? Let me know your thoughts on the 23andMe saga in the comments below. You can also join me this Friday at 12 ET for the weekly #HITsm tweet chat. We’ll be touching on the impact 23andMe’s big genetics data could have on healthcare, provided they’re allowed to stay in business.

athenahealth Partners With Quality Group To Research EMR Patient Safety

Posted on November 15, 2013 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 @annezieger on Twitter.

While it’s known that EMRs have been involved with, and probably responsible for, patient harm and even death, research is incomplete and sketchy on what risks are the most pressing and how to avoid them. Plus, we’re always balancing these risks with the potential benefits of EMR as well.

One recent study by the Pennsylvania Patient Safety Authority concluded that EMR default settings for medications caused adverse events in more than 3 percent of cases reviewed by the organization.

But that’s just one study, which can only do so much to help on its own. To get a better grip on such issues, EMR and practice management vendor athenahealth has partnered with Patient Safety Organization Quantros to examine the impact that EMRs are having on patient care. The research project is being funded by athenahealth, according to  a piece in Medical  Practice Insider.

athenahealth is offering its national network of about 47,000 providers free access to Quantros’ Safety Event Manager reporting tool, allowing athena’s EMR clients to submit patient safety data directly to the Quantros Patient Safety Center. Delivering the safety data through a PSO like Quantros insulates providers from liability by offering discovery protections when the practices report and analyze a potential issue, Medical  Practice Insider reports.

As one might expect, athena is mounting the experiment to find out when use of its EMR might have contributed to a  potential adverse event, such as, for example, when the EMR fails to warn a physician that a prescribed drug would interact with a drug the patient is already taking.

The bottom line, for athena, is to analyze the data for patient safety trends, and use it directly to improve its technology, said Tarah Hirschey, athena’s senior manager of patient safety, to Medical  Practice Insider.

Study Suggests That Health IT Can Boost Doc Productivity

Posted on November 11, 2013 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 @annezieger on Twitter.

We’ve all heard stories about medical practices whose productivity crashed when they brought an EMR on board, for reasons that range from workflow problems to training gaps to problems with a wonky system.  But if the following study is right, there’s reason to hope that health IT will actually improve productivity over time, according to a story in Medical Practice Insider.

According to research published in journal Health Affairs, physicians with health IT on board will be able to serve about 8 percent to 15 percent more patients than they could without health IT tools. And in practices where doctors have higher levels of EMR or portal adoption, the spike could be higher, according to the research, whose team includes former national coordinator David Blumenthal.

Meanwhile, practices that adopt emerging technologies such as remote care could allow doctors to perform 5 to 10 percent of care to patients outside of the office visit, and 5 to 15 percent of care could be performed asynchronously, reports Medical Practice Insider.

Another study cited by the article, done by the National Center for Health Statistics, notes that EMRs can offer varied clinical and financial benefits, such as greater availability of patient records at the point of care. And adjunct tools like e-prescribing capabilities and the ability to retrieve lab results can save time and effort, the NCHS study concludes.

These studies are encouraging, but they don’t say much about how practices can manage the workflow problems that keep them from realizing these results. While I have little doubt that health IT can increase productivity in medical practices, it’s not going to happen quickly for most.  By all means, assume your medical practice will eventually leverage health IT successfully, but it won’t happen overnight.

P.S. In the mean time, take a look at this list of factors in creating satisfied EMR users. It might help you speed up the day when productivity climbs.

Use Of Surescripts E-Prescribing Up Dramatically

Posted on October 21, 2013 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 @annezieger on Twitter.

E-prescribing has become almost commonplace, if not universally used, among providers with EMRs during the last four years, a new study concludes. The study, which was published in The American Journal of Managed Care, was conducted by a team led by ONCHIT’s Meghan  H. Gabriel, PhD.

Researchers found that between 2008 and 2012, the total number of e-prescribers using Surescripts shot up from 7 percent (47,000 providers) to 54 percent (398,000), according to a report in EHR Intelligence.

As EHR Intelligence notes, these numbers didn’t just appear out of nowhere. Part of the reason e-prescribing has gained so much ground is that 94 percent of pharmacies are now able to accept e-prescriptions, up from 61 percent in December 2008.

It’s a good thing pharmacies are on board. E-prescribing must be in place  — specifically, certified EHR technology (CEHRT) — to meet one of the requirements of Stage 2 Meaningful Use. The requirement is that eligible providers need to transmit more than 50 percent of “all permissible prescriptions” via their CEHRT, EHR Intelligence points out, 10 percent higher than the Stage 1 requirement.

Side note: CMS seems happy with e-prescribing progress to date. According to the agency, more than 190 million electronic prescriptions had been sent by doctors, physician’s assistants and other healthcare  providers using EMRs. That 190 million is the cumulative total sent since the inception of the Meaningful Use program in 2011.

But from my way of looking at things, it isn’t completely kosher that e-prescribing by providers is barely over the half-way mark, despite representing considerable improvement over the years. While 54 percent is a nice round number, it still suggests that nearly half of providers are not equipped to achieve compliance with Meaningful Use Stage 2, an undesirable situation at best.

No, despite the improvement in e-prescribing uptake, to me the current stats actually look like a problem, not a win at this stage. The 46 percent of providers not online with e-prescribing had better get their act together.

Doctors: EMRs Can Be Quality Obstacles

Posted on October 15, 2013 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 @annezieger on Twitter.

Many doctors believe that today’s EMRs are difficult to use and stand in the way of quality care at times, according to a new RAND Corporation research report covered by Healthcare IT News.

The RAND report comes from a project, sponsored by the American Medical Association, which was designed to identify what influences doctors’ professional satisfaction.

To research the report, RAND surveyed 30 physician practices in six states–Colorado, Massachusetts, North Carolina, Texas Washington and Wisconsin. RAND researchers also visited each of the practices on site, conducting in-depth interviews with 220 doctors, medical administrators and allied health professionals to see what drives doctors’ satisfaction with their work lives.

One key finding of the report was that being able to provide high-quality care is a primary factor in job satisfaction for physicians — and that anything which hinders them from doing so is a source of stress. And one critical factor that doctors feel impedes their ability to deliver good care is the requirement to use EMRs, Healthcare IT News notes.

Doctors who responded to the survey told RAND that current EMR technology gets in the way of face-to-face discussions with patients, demands that physicians spend too much time on clerical work and lowers the accuracy of medical records by encouraging the use of template-generated notes, according to Healthcare IT News.

What’s more, doctors told RAND that they’re unhappy that EMRs have been more costly than expected, and that the lack of interoperability between various EMRs has been a major frustration, as  it keeps them from easily sending patient data where it’s needed and when it’s needed.

Medical practices are trying to reduce doctor frustration by hiring staffers to perform many tasks involved in maintaining electronic records. And practices are attempting to improve physician satisfaction in other ways, such as giving them more independence in structuring clinical activities and allowing more control over the pace and content of the care they provide.

Still, it’s telling that as many as one-fifth of practices might switch EMRs, searching for an system that solves problems rather than creating new ones.  Whatever practices are doing to help physicians achieve satisfaction with their current EMR, it doesn’t seem to be working very well.

Study: Patient Portal Use To Shoot Up 221 Percent

Posted on October 7, 2013 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 @annezieger on Twitter.

The US patient portal market should grow at a blazing clip over the next few years, according to a new report by research firm Frost & Sullivan.

The new study, U.S. Patient Portal Market for Hospitals and Physicians: Overview and Outlook, 2012- 2017, concludes that the total US patient portal market for hospitals and physicians generated revenue of just $279.8 million in 2012. By 2017, however, the US patient portal market should reach $898.4 million, representing a 221.1 percent increase in revenue generated.

Growth in portal use is being fueled partly by the easy availability of such technology. About 50 percent of US hospitals and 40 percent of US physicians in ambulatory practice own some type of patient portal technology, researchers say, mostly acquired as a module of their EMR or practice management system. Frost & Sullivan dub this generation of portals ” Patient Portal 1.0.”

The report notes that providers are using the current generation of patient portals for efforts around patient engagement, such as access to medical records, communication with providers and e-visits.

For example, three large health systems recently completed a study in which roughly 4,000 patients were given access not only to their medical records but also their doctors’ notes via a patient portal.  Despite having privacy concerns, 99 percent of patients involved in the study wanted continued access to physician notes by a portal.

But the growth in patient portal use will be driven by other factors as well. Researchers say increased portal deployment will be driven by several factors, including the need to meet Stage 2 Meaningful Use requirements and growing consumer demand for health IT options.

Soon, providers will need more advanced technology to meet the goals they have for patient portals, said Frost & Sullivan Connected Health Principal Analyst Nancy Fabozzi in a company statement.

“As healthcare reform and transformation advances, providers will seek new ways to engage patients and influence behavior beyond the point of care,” Fabozzi said. “These solutions, which can be considered “Patient Portal 2.0,” will have robust functions such as health information exchange across diverse care settings, integration of clinical and financial data, dynamic scheduling, social networking, gaming, avatars for personalized health coaching and e-visits.”

Patients Want Access To Physician Notes Despite Privacy Concerns

Posted on October 4, 2013 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 @annezieger on Twitter.

While privacy concerns remain, patients’ desire to access their medical records online seems to outweigh those concerns, according to a study reported in iHealthBeat.

The study, which was published in the Journal of Medical Internet Research, included 3,874 primary care patients at Beth Israel Deaconess Medical Center, Geisinger Health System and Harborview Medical Center. Each of these institutions implemented OpenNotes, a portal which allows patients to read the notes written by their doctors following office visits, e-mail correspondence and phone calls. The patients were able to view the notes via the portals where other parts of their medical records are stored.

Researchers interviewed patients at baseline, prior to their using the OpenNotes portal. They were interviewed again after a one year period during which they were able to use the OpenNotes portal to review the notes doctors made during their visits.

Privacy remained a concern throughout the study period, iHealthBeat noted. At the study’s outset, about 33 percent of OpenNotes project participants reported having concerns about privacy;  meanwhile, almost 37 percent said they were concerned about privacy after the one year period of using the portal.

After using the portal  for a year, 15.5 percent of patients said they were more concerned about privacy, while 12.7 percent said they were less concerned about privacy.

That being said, study participants were still very enthusiastic about having access to the notes. In fact, at the study’s end, 99 percent of participants said they wanted continued access physician notes, despite their initial privacy concerns.

In April of last year, when I first wrote about this project, I  predicted that patients would become very attached to the level of intimacy OpenNotes would offer with their providers.  It seems that this has come to pass. If 99 percent of patients want to continue with the project despite having privacy concerns, that’s a ringing endorsement of the concept. Now, I’m curious as to whether other institutions will get on board.

Simpler EMRs Lower Physician Stress

Posted on September 23, 2013 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 @annezieger on Twitter.

When it comes to EMRs, simpler may be better, according to a new study. 

Researchers have concluded that doctors who use EMRs with a moderate number of functions are more stressed out and have a lower level of job satisfaction than those who use EMRs with fewer functions.

The study also suggested that doctors who used highly functioning EMRs are especially challenged providing care if they feel the time allowed to do so isn’t adequate.

The study, which was reported in Healthcare Informatics magazine, originally appeared in the Journal of the American Medical Informatics Association. In the study, researchers examined variables including doctor-reported stress, burnout, satisfaction and intent to leave the practice, then used these variables to compare decisions before and after EMR systems were implemented.

To gauge how physicians react to EMR features, the study authors looked at 379 primary care physicians, along with 92 managers at 92 clinics from New York City and the upper Midwest.

The physicians and managers were participating in the Minimizing Error, Maximizing Outcome study, a 2001 – 2005 study assessing relationships between the structure and culture of the primary care workplace, physician stress and burnout, and the quality of care experienced by their patients, Healthcare Informatics reported.

The researchers actually found the job stress went down slightly for physicians using sophisticated EMR system compared to physicians with moderately complex EMRs. However, time pressure during examinations was more highly associated with adverse physician outcomes in the high EMR function group, the study authors wrote.

It’s worth remembering, however, that EMR complexity isn’t the only factor which determines how comfortable physicians are with their system.

Ultimately, seeing to it that doctors are comfortable with EMR features and functions before they’re installed and set in stone is the best way to see to their satisfaction, according to health IT expert Mark Olschesky.