I love the title of this post since it uses the word change. People when they see change start to get really concerned. For some reason we don’t generally like change. We often like it after the fact, but rarely want to engage in change. I’ll be the first to tell you that implementing an EMR requires change. Anyone who tells you otherwise probably has something to sell you. Certainly some EMR require more change than others, but they all require a change.

The American Medical News put out an interesting article discussing what they said would be 5 ways meaningful use will change your practice. Here’s their 5 ways and my commentary on each of the items:

Patients will be more involved in their care – Certainly meaningful use has some requirements that encourage the sharing of clinical information with the patient. I expect in future meaningful use stages we’ll see even more sharing of the clinical information with the patient. However, I don’t really see this sharing as translating to a more involved patient. Tons of people miss incorrect charges on their bank account and credit card statements and they have all that information. I’m sure the same will happen as patients get access to this information. Many won’t care to look and many of those that do look won’t have much of an idea what they’re looking at.

With this said, there is a general movement to the active and involved patient. Combine the easy access to health information (good and bad information I might add), the easy social interactions amongst patients (ie. asking your friends on Facebook), and other changes we see in society and the patients will be more involved going forward. I just don’t see meaningful use being a huge driver for this.

Doctors will find it easier to see how they’re doing – Ummm…this seems way off base to me. First, because it’s pretty hard to define “how they’re doing.” So, it makes it hard to talk about. Let’s just focus on the meaningful use measures. Does anyone really think that tracking the meaningful use measures is going to make a doctor better at what they’re doing? Can they really be used to measure how well a doctor is doing? I guess I just don’t think meaningful use is the right “report card” for doctors.

Physicians will collaborate more with other doctors – Stage 1 definitely does little to help this happen more efficiently. We’ll see if stage 2 or 3 takes it much farther. Although, if stage 3 takes it too far, I imagine many will opt out of showing meaningful use for stage 3 since the payouts are so small at the end of the EHR incentive money.

Long term, having an EMR will facilitate collaboration and information sharing amongst doctors. However, we don’t have the highways for that information built yet.

Physicians will pinpoint practice inefficiencies – This feels a little like the second one to me. However, it’s worth also pointing out that I think it would be a very difficult argument to make that meaningful use somehow makes a practice more efficient. I could certainly make an argument (which I’m sure many would love to argue against) that an EMR can make a clinic more efficient, but not meaningful use.

Physicians will need a firmer grip on data security – MU stage 1 has little HIPAA requirements and I don’t expect MU stage 2 and 3 to change that. There are some privacy and security requirements in the EHR certification that try and take data security and privacy in an EMR to the next level. Also, the HITECH act has provided some “teeth” to the enforcement of HIPAA which it never had before. I still think we need a few more clinics to get “bitten” by it to really understand what the requirements are going to be and how they’re going to enforce it.

The CDC recently did a survey of EMR use in doctor’s offices and they reported that EMR use rose to 50.7% in 2010. The 50.7% of physicians estimated to use EMR systems in 2010 was up from 48.3% in 2009, 42% in 2008 and 34.8% in 2007. Well, with that data, I think it’s pretty clear that they have some issues defining EMR use, no?

Here’s a paragraph from the American Medical News article on the study:

The latest CDC information on EMR use, released on Dec. 14, 2010, was based on surveys mailed to 10,301 physicians between April and July 2010. About two-thirds of physicians responded to the survey, according to the CDC. The 50.7% of physicians estimated to use such systems in 2010 was up from 48.3% in 2009, 42% in 2008 and 34.8% in 2007. The 2010 estimate is preliminary, because it relies only on the mailed responses and not answers gathered through follow-up calls. The CDC National Center for Health Statistics counted as an EMR any system that is all or partially electronic and is not used exclusively for billing.

So, from this paragraph let me provide a better conclusion: 50.7% of Physicians use some form of software in their clinic.

As most of you know, I’m not a huge fan of arguing over the definition of words, but to say that over 50% of doctors use EMR is laughable since their definition of EMR is so broad. Here’s the real details from the study on what percentage actually really use an EMR (as most people would define EMR):

According to the survey, 24.9% of office-based physicians had access to a “basic” EMR system, while only 10.1% had a “fully functional” system.

I think their definition of “fully functional” EMR system is probably too stringent. Their definition of “basic” EMR system is probably too simple. So, I’d conclude that actual EMR use is somewhere between 10% and 34.9% or 22.45% if we average the 2 numbers. Close to 25% EMR adoption feels like the right number to me, so I’m glad to see the real data supports that conclusion.

What the 50% number does indicate is that half of physicians are looking at electronic methods to improve their office. I’d project that another 25% are seriously considering the idea of implementing an EMR, but haven’t done anything yet. 75% (using my projections) of doctors interested in EMR and other technology is still a bit far from the 100% number, but considering the past history of healthcare IT I’ll say that’s progress.

Here’s the story from the American Medical News:

The Mayo Clinic announced the launch of a new personal health record system that will be available to anyone, including those who are not Mayo patients. Those involved with the project say the system, powered by Microsoft HealthVault, could also carry benefits for non-Mayo physicians.

Is it just me, or is my headline (which is theirs also) really misleading? When I saw the headline I was really interested to see the type of PHR that Mayo Clinic had created. Instead, all they’re doing is adopting Microsoft HealthVault. That’s a big win for Microsoft HealthVault, but that’s been publicly available for a while. I’m not sure why Mayo Clinic joining HealthVault makes it any more available to those outside of Mayo.

The more interesting part of the article is when they talk about Mayo Clinic moving forward despite Beth Israel Deaconess Medical Center in Boston stopping claims data from being sent to Google Health:

The launch of Mayo’s system came days after Beth Israel Deaconess Medical Center in Boston announced it would stop sending claims data to patients’ Google Health accounts due to the possibility that the data contain errors. The move reignited the debate over whether PHRs can contain too much data that is not useful to physicians, or dangerous for them to rely on.

Mayo’s system will allow the import of claims data through Health Vault, but Mayo’s physicians will likely not use it, the organization said. Other patients and their physicians can choose whether the information is relevant enough to be kept.

I’d still like to see better support for PHR in various EMR and EHR products. However, until there’s a good standard I don’t expect that to happen anytime soon.