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A Thoughtful Approach to EHR Implementation – 5 Tips

Posted on May 9, 2013 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.

While many in the EHR industry have started moving beyond EHR implementation, it’s worth realizing that only 55% of physicians have adopted an electronic health record (EHR). Yes, that means that 45% of physicians are still working on selecting and adopting an EHR. Ok, it’s probably more like 40% of doctors are looking to implement an EHR. The other 5% will stick with their paper.

Plus, along with the 45% of doctors who don’t use EHR, there are a whole slew of existing EHR users that are selecting and implementing an EHR as well. For example, 2 days ago I was at my son’s cub scout event where an opthamologist friend of mine cornered me and asked me about how he should go about selecting an EHR for his practice. He had just decided to go out on his own and open his own opthamology practice. What a perfect time to select and implement an EHR.

With this in mind, today I came across this whitepaper by ADP AdvancedMD called A Thoughtful Approach to EHR Implementation. They provide a number of stats, charts, and graphs using data from the CDC about EHR satisfaction and EHR use. The most intriguing number to me was the number of physicians that reported accessing the patient chart remotely using their EHR. That’s an EHR benefit that I don’t see talked about very often.

The whitepaper also offered these 5 tips for a successful EHR Implementation:

  1. Stay committed to your goal, but flexible in your approach
  2. Don’t short-change your training opportunities
  3. Don’t underestimate the impact to your workflow
  4. To pilot or not to pilot
  5. Optimizing the EHR

A lot more could be said about each point and they cover each point in detail in the full whitepaper, but the first and third ones really stand out to me. EHR is a commitment, but requires some flexibility. The best way to have a failed EHR implementation is to not be committed or to be inflexible. Your workflow will be impacted, but if you take a thoughtful approach to your EHR implementation it can be impacted for good.

MyPassport, Transcription Costs, and CDC App — Around Healthcare Scene

Posted on January 20, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Hospital EHR and EMR

Hospitals Beware: EMR Copy and Paste Common

EMR Templates can be helpful, but also makes life harder as well. A recent study found that 82 percent of progress notes by residents had 20 percent or more copied and pasted material. This function is tempting for physicians who need to cut time somewhere, but its something that needs to be watched out for and prevented.

iPad App Helps Patients Understand Inpatient Care Process

In an effort to eliminate confusion that often comes during an inpatient stay, Boston Children’s Hospital has developed an iPad app. The app, called MyPassport, helps patients understand more about what is going on during their stay. It displays photos of doctors and nurses, others involved in care, as well as lab results that have been condensed to patient-friendly terms.

EMR, EHR, and HIPAA

EHR Benefit — Transcription Costs Savings

This is the next part of the EHR benefits series. Many doctors were thrilled to give up their transcription for an EHR in hopes of saving costs. However, some are feeling that their EHR may not be the best solution after all. Because of this, some are wanting to implement transcription services again. So, for some, eliminating transcription may not have saved as much money as some had hoped.

Mixing Physical, Mental Health Data Lowers Readmissions

Physicians aren’t often given access to the psychiatric records of patients they are treating. However, a study by Johns Hopkins found that perhaps they should be. The study showed that a signficant percentage of patients whose physicians had access to both physical and mental health data had a smaller readmission rate than those whose mental health records weren’t available.

Smart Phone Healthcare

CDC Launches New Mobile App

The CDC is getting into mHealth with the recent release of their mobile app. The app has many different features, such as health articles, quizzes, and a news room with information outbreaks or other pertinent information. The app is free and definitely one that should be downloaded if you enjoy hearing about health news.

Google Gets Into Activity Tracking

After the failure of Google Health, Google is making an attempt to get into the activity tracking world. “Google Now” basically turns the phone into a personal tracking device, including for fitness. It isn’t as accurate as some of the more sophisticated tracking devices out there, but it is a lot easier to use because it is embedded into the phone. It may make it easier for people to

Cognitive Dissonance and EMRs

Posted on July 18, 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new CDC study has documented what’s pretty much old news to us EMR watchers, that more than half of U.S. doctors have taken their charts digital. The study also concluded that most are pretty happy with their EMR, heaven help us, and that it’s improved patient care.

According to a study by the CDC’s National Center for Health Statistics, 55 percent of U.S. doctors have adopted some type of EMR.  More interestingly, for folks like me at least, 75 percent of those who have have met Meaningful Use Stage 1 criteria, something I might not have predicted if I hadn’t read the study.

This seems a bit strange to me, honestly. I’ve talked to countless doctors about their EMRs, both hospital- and practice-based, and I’ve only met a couple who actually felt satisfied with the system(s) they use. I haven’t met any that felt the systems have improved patient care, though I admit my sample isn’t drawn scientifically. (Vendors, I’m not saying that *nobody’s* happy, just that these numbers sound high, to be clear.)

The best explanation I can come up with for such results, which came from 3,200 doctors completing a mail-in survey, is the impact of cognitive dissonance.  Let me explain.

Doctors are being  pressured with thumb screws to make the switch, and it’s hardly surprising that most have come around.  So they’ve gone ahead and spent what in some cases are huge sums of money to make the leap.

The thing is, when you’re forced to use something every day, you can’t just keep on hating it more and more. Nobody has that much energy.  So over time, you resolve the cognitive dissonance — the battling “EMR painful” and “EMR necessary” thoughts — by learning to love Big Brother EMR, or at least believe that you do.

Then again, though I’d have trouble believing this, maybe there’s hordes of satisfied doctors that never come to the attention of a cynic like me. What do you think?

EMRs Have Potential Role to Play in Curbing Global Contagion

Posted on July 11, 2012 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 had some rare time to myself at home the other night and decided to finally watch the Netflix DVD that had literally been gathering dust on our entertainment center. (No matter how hard I try, I can’t seem to watch a movie and return it in less than a week these days.) For better or worse, I popped in the star-studded, virus-filled Contagion – an ode to the absolute insanity that could befall modern society should a highly contagious and highly untreatable virus strike nearly every society on Earth.

Other than the autopsy scene in which Gwyneth Paltrow’s character – otherwise known as the “index patient” – gets what I’ll delicately call a “facial,” I was pretty fascinated by the inner workings, procedures, protocol and backstabbing of the CDC and WHO. They, of course, used technology to track the virus’ origin and its rapid spread, and I kept waiting to hear a doctor refer to accessing victims’ electronic medical records to track development of their illnesses. (Come to think of it, this movie would have made for great EMR product placement opportunities.)

Though EMRs were given short shrift, the movie made a good case for population health management, and the corresponding role technology can potentially play in tracking outbreaks. I wondered if such an outbreak were to actually ever occur, would EMRs, HIEs and other data exchange programs help providers isolate worst cases of conatgion quicker?

Coming across a headline like “Officials search for more clues in disease killing Cambodian children” makes me wonder if the CDC and WHO are using population health management tools in their investigations, and if data exchange is playing a part in developing countries like Cambodia. A quick Google search of Kantha Bopha Children’s Hospitals, which seems to be ground zero for treatment of the outbreak, leads me to believe the hospitals likely don’t have the resources for sophisticated healthcare IT systems. A broader search for mention of EMRs in Cambodia yielded information from late last year on University Research Company’s Cambodia Better Health Systems Project participating in an Open Medical Record System Annual Implementer’s Meeting meeting in Rwanda, focused on enhancing EMR systems. So it seems that EMRs are definitely on the country’s radar to some extent.

Could EMRs in a developing country like Cambodia help to contain the spread of highly contagious diseases? Could they at least help spread message of the contagion amongst providers across affected regions, helping to transmit daily updates regarding spread, treatment, cause, etc.? These are all questions I’m sure global health agencies have already spent considerable time considering. I came across a very interesting report from the Rockefeller Foundation and its partners on this very subject. Highly recommended reading: “The Promise of Electronic Medical Records (PDF).”

Are you aware of more up-to-date implementations of EMRs in developing countries? Any third-world success stories we should know about? Please share your thoughts in the comments below.

Physician Adoption of EMRs Growing, But Don’t Expect A Landslide

Posted on February 26, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

About 30 years ago, when cable television hit its stride,  pundits watching the industry assumed that home adoption would quickly climb to near 100 percent. Instead, for a variety of reasons, consumer adoption more or less froze at the 50 percent mark for many years.

Maybe the industry didn’t their pricing strategy right; maybe consumers were perfectly happy with broadcast television; or  maybe the existing broadcast networks greased a few palms and helped regulators slow down its growth in subtle ways.

In any event, the cable industry has improved its performance enormously; in fact, it hit 70% in the late 90s, though that number has fallen significantly as satellite providers have horned in.

So, why bring up cable TV in a forum aimed at dissecting the EMR business?  Because I think the cable industry’s experience is instructive in how we think about EMR adoption.

First, some data points.  According to study released in January by the CDC’s National Center for Health Statistics, 50.7 percent of physicians were using EMRs in their offices in 2010.  That’s a dramatic upswing from previous years, the agency noted.

Of course, practices are eager to collect Meaningful Use incentives if they can.  Also, as older physicians retire, younger, more-wired MDs are taking up the EMR banner. (In fact, CDC data concludes that the younger a physician is, the more likely they were to adopt EMR technology.)

Not only that, hospitals are helping to grease the skids, with one-third offering to subsidize EMR buys and 60 percent offering doctors access to the facility’s EMR, the CDC found.

All of that sounds great, particularly if you’re an EMR vendor.  But I think it’s a bit early, as it was for cable pundits, to predict that EMR adoption is at some kind of tipping point.  Whiz-bang technology always looks great from the peanut gallery — especially to analysts and editors — but it often looks different on the ground.

Not only do I think exponential growth is unlikely, I’d argue that adoption by physicians will be painfully slow for at least a few years more, gaining say, 5 to 7 percentage points a year at best.

Why do I feel that way?  Here’s a few reasons:

*  Few (if any) vendors can honestly say that introducing their product won’t bog down a practice and trash its productivity for months at least.  Doctors know this.

*  Smaller practices don’t, and aren’t likely to, have full-time IT staffers.  Even practices that want to adopt don’t have the reassurance of a dedicated IT brain that knows their needs. Under these circumstances, buying an EMR is a scary investment.

* Other trends that might spark EMR adoption — such as the emergence of RHIOs/HIEs — are moving at a snail’s pace.  If a doctor doesn’t have the added incentive of sharing patient data to spark adoption, that’s one more reason to delay.

Look, maybe I’m being pessimistic, or short-sighted. But I simply don’t think the EMR vendor market nor the physician buyer side have gelled enough to spark a revolution. I guess we’ll just have to wait and see.

Physician EMR Use Passes 50% – Yeah Right…

Posted on January 12, 2011 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 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.

EMR Adoption Trends

Posted on December 7, 2010 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 always interesting and passionate Al Borges, MD posted a comment in response to my post from over a year ago about EMR tire kickers and EMR Adoption:

>>> “I think we’re going to see a tremendous increase in EMR purchases at that point in time.”

Why did you believe this back then, John?

Doctors aren’t stupid- most won’t throw themselves at MU’s $44,000.00 only to be left straddled with a loss from year 1 due to the estimated costs of owning an EHR and doing MU for eternity of $40-60,000.00 per year.

Time has shown that the HIT industry has stagnated, with few doctors now buying into the politically driven HITECH Act. I can’t wait until the next CDC biyearly report…

Here’s my response to Al’s comment:

Al,
I still think that statement’s true. There’s going to be a spike in those that purchase EMR software to get the EMR stimulus money. Many were already considering buying it before the stimulus and now a good number of doctors will buy an EMR now that we have the details and timelines for the EMR stimulus.

After this jump in sales, it’s then going to be interesting to watch. The future sales of EMR software are going to be highly dependent on the experience of these initial EMR implementations. If they’re successful and doctors like their EMR and get the EMR stimulus money, then we’ll see more EMR adoption. If they don’t like it or have trouble getting the EMR stimulus money or experience many of the headaches of EMR adoption that we’ve seen before, then I believe it will actually set EMR adoption back long term.

I know which way you lean on that scale. I still think the jury is out, but I am concerned that the later scenario is a distinct possibility.

If the later scenario of an EMR adoption setback occurs, I’m not sure we’ll come out of it until the next generation of “digital natives” finish medical school and achieve prominent enough status in a clinic to push EMR adoption again.

I did misjudge the time it would take to really get the details of the EMR stimulus in place. I thought by February or March of 2010 we’d have known more than we did. Turns out the legislative details took much longer than I expected, but I think we’ll see the EMR adoption spike now that the details are finally in. At least that’s the view I see as far as action and interest in selecting and implementing an EMR.

What do you guys think? How is EMR adoption going and what EMR adoption trends do you see happening in the future?