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Providers In Underserved Areas Lagging On EMR Implementation

Posted on July 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.

Providers in large metros are less likely to have implemented EMRs than those in smaller metro areas and rural areas, according to a study written up by Healthcare Informatics.

The study, which appeared in Health Services Research, set out to determine whether EMR adoption was lower in traditionally underserved areas. To look at this issue, in 2011 researchers gathered data from 261,973 ambulatory healthcare sites with 716,160 providers, covering 50 states and the District of Columbia. Provider sites ranged from one-physician practices to large multi-physician groups, Healthcare Informatics reports.

Researchers found that areas with high concentrations of minority and low income populations, as well as those in large metropolitan areas were more likely to be in the lowest quartile of EMR adoption nationally, as compared with rural areas. The study also found that 43 percent of providers working in ambulatory healthcare sites had EMRs with e-prescribing capabilities, Healthcare Informatics reports.

Clearly, if researchers were expecting to find a lack of EMR adoption in these metro practices, they hit the nail on the head. I’d like to know, however, why things fell out this way.

Are metro practices lacking the resources to adopt EMRs in a more pronounced way than rural practices? Is there some phenomenon in the works in which underserved populations aren’t expecting EMRs, and therefore aren’t pressuring providers to implement them?

It’s worth noting that according to HIMSS data for Q1 2013, about 50 percent of ambulatory providers were still paper-based, and that nearly half of remaining practices were still stuck at Level 3 of adoption (CDR, access to results from outside facilities) or lower.

I’d argue that the gap between practices with mature implementations and those who are barely crawling is of equal importance and worth a study of its own. In the meantime, it is worth considering what can be done — beyond Meaningful Use incentives, clearly, or the gap wouldn’t exist — to be sure that EMR uptake doesn’t hit a snag with metro providers.

Where Are Usability Standards For EMRs?

Posted on December 7, 2012 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 other day, I was talking with a physician about ambulatory EMRs.  “None of them are any good,” said the doctor, who’s studied EMRs for several years but never invested in one. “I can’t find a single one that I can use.”

Are any of you surprised to hear him say that? I’m certainly not.  Perhaps he’s exaggerating a bit when he says that absolutely none are usable at all, but it’s hard to argue that doctors cope with a counter intuitive mess far too often.  And of course, enterprise EMRs get if anything lower usability ratings from practicing doctors.

All of which brings me around to the notion of EMR usability standards, or rather, the lack of such same. While those in the industry talk often about usability, there’s no real consensus standard for measuring how usable a particular EMR is, despite noble efforts by NIST and impassioned advocacy by usability gurus in the field.

Certainly, private research organizations take usability into account when they survey clinicians on which EMRs they prefer. So clunky EMRs with lousy UIs do pay some kind of price when they’re rated by the clinical user. But that’s a far cry from having a standard in place by which medical practices and hospitals can objectively consider how usable their preferred EMR is going to be.

So, why don’t we have usability standards already in place?  The market still hasn’t punished vendors whose EMRs are a pain to use, so vendors keep on turning our products built around IT rather than clinical needs. The doctor I spoke with may have opted out of the EMR market, but most providers aren’t going to do that, Meaningful Use incentives being just one reason why. (It’s a “handwriting is on the wall” thing.)

It’s a shame CMS isn’t pushing vendors to produce Meaningfully Use-ABLE EMRs. That might do the trick.

Hospital Preparation for Meaningful Use

Posted on November 18, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

HIMSS Analytics recently sent out some interesting results from a survey the did of hospital’s preparation for meaningful use. Here’s the results:

*Nearly one quarter (22 percent) of participating hospitals have the capability to achieve 10 or more of the required core measures in the meaningful use Stage 1 requirements.

*Some 34 percent of respondents have the capability to achieve between five and nine of the core measures for meaningful use.

*Just over 40 percent (40.47 percent) of the market indicated they have the capability to meet five or more of the menu items for meaningful use.


Click on the images to see the larger images.

As lone data points it’s hard to judge if hospitals are making progress or not. I’ve heard many people say that hospitals are going full bore towards meaningful use and that ambulatory practices are slower to adopt EMR and meaningful use. I’m not sure this is totally true. Plus, the lead time needed to implement in an ambulatory setting is so much shorter than in a hospital. Even a hospital that owns ambulatory practices.

I’m told that HIMSS Analytics will be doing this same survey every couple months. I’ll see about publishing the results as I get them so we can compare the change.

EMR US Adoption Rates

Posted on November 21, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

People are always interested in learning what the adoption rates for EMR software are in the US. Chilmark recently posted about a Harvard School of Public Health study that was presented at the PHAT conference. This study focused on EMR adoption rates and the reasons that doctors and practice managers have chosen not to adopt an EMR, yet. Here’s a summary of the findings:

Hospital EMR

  • 90% of Hospitals have no functional comprehensive EHR
  • Mostly large hospitals and teaching hospitals do
  • Top Barriers to EMR Adoption: Inadequate capital (73%), maintenance costs (44%) and physician resistance (36%)

Ambulatory EMR

  • 83% do not have a functional EHR
  • 17% stated they have purchased an EHR, but not implemented
  • 26% plan to purchase an EMR in the next 2 years
  • Top Barriers to EMR Adoption: lack of capital (67%), finding a system that meets their needs (54%) and uncertainty of ROI (51%)