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EMR, HIE Use Up Sharply In U.S.

A new survey by Accenture has concluded that the number of U.S. doctors using EMRs — either in their practice or at a hospital — has climbed to over 90 percent, and that almost half are using HIEs. More than half of doctors surveyed (60%) report using an EMR in their own medical practice.

The Accenture survey reached out to 3,700 doctors in eight countries, including Australia, Canada, England, France, Germany, Singapore, Spain and the U.S.  Data showed a spike in healthcare IT usage across all of the countries surveyed.

In the U.S., doctors had the biggest increase in adoption demonstrated in the survey, up 32 percent in routine use of health IT capabilities, as opposed to an average increase of 15 percent among non-U.S. clinicians, reports HealthcareIT News.

Other standout activities were e-prescribing (65 percent using) and entering patient notes into EMRs (78 percent), a 34 percent annual increase between 2011 and 2012. Forty-five percent of physicians also use IT for basic clinical tasks such as getting alerts while seeing patients (45 percent), according to Healthcare IT News.

Healthcare IT News also caught an interesting detail around lab orders. The magazine notes that 57 percent of U.S. doctors said they regularly use electronic lab orders  (a 21 percent annual increase) the volume of physicians doing so internationally dropped 6 percent.

Globally, the number of doctors who “routinely” access clinical data on patients seen by different health organizations has climbed by 42 percent, from 33 percent of doctors in 2011 to 47 percent in 2012. Spain was the leader by a significant margin, with 69 percent of doctors routinely accessing such data.

The study also concluded that internationally, almost 60 percent of doctors customarily enter patient notes electronically either during or after consults.

On the other hand, so-called “digital doctors” are still unlikely to connect or transact electronically with outside organizations. Accenture found that only 10 percent of physicians communicate electronically to support remote consults/diagnostics, and that roughly 20 percent e-prescribe, receive notifications of patients’ interactions with other health organizations and communicate electronically with clinicians in other organizations.

May 10, 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.

Cash for Care a Trickle-Down Effect of EMR Dissatisfaction?

By now we’ve all heard about or read of the group of dissatisfied EMR users – hospitals and small-practice physicians who bought into the notion of government incentives – and a better way to deliver healthcare with the added benefit of more efficient processing and payment collection from patients and payers – but aren’t seeing the ROI they initially anticipated. Say what you will about this group, but one thing is for sure: Investment in healthcare IT systems like EMRs have led some physicians to turn to hospital employment, others to close up shop, and yet others to turn to more unique business models such as concierge or cash-only practices.

On the flip side of this change in healthcare delivery is an increasing demand from patients to know just what their dollars are paying for, no matter whether those dollars pay into a monthly insurance premium or directly for services rendered. I wouldn’t say we’re yet at the point where this demand is a trend, but I do believe that as more and more mainstream media outlets cover the debate over healthcare costs and price transparency, more patients like you and me will learn how to ask for costs up front, how to shop around, and most importantly, how to determine if what we’re paying for is worth it.

Entrepreneurs didn’t take long to catch wind of this, and as a result we’re seeing a number of consumer-friendly healthcare businesses pop up. Take Healthpons, for instance. I came across mention of this company a few weeks ago, and was intrigued by its Groupon model for healthcare services. The company offers one line of service for providers, and another for patients. According to its website, Healthpons offers a free portal that allows physicians to market their services at a cash price so that patients can quickly search for said practice and service by city, state, zip, specialty or symptom checker; purchase services and set appointments online. Patients, in turn, can use the portal to search for providers, find the one with the best price, and use a Healthpons discount to pay in advance and make an appointment at the same time.

I chatted with Healthpons co-founder Patty Everette, to learn more about the business:

How do you qualify providers to participate in the program?
We have a system, similar to an insurance company, to review and verify credentials of all providers. This is why we are in a pre-launch phase to validate providers prior to posting their information.

How many providers have signed up?
We have validated about 6,000 providers and many more have enrolled.

The website mentions the patient portal will go live in all 50 states in 2013 – can you give us a more exact timeline?
June 2013 is our target launch. All validated providers will be posted, however, there are certain geographic areas that have a higher concentration of providers, such as the Southeast, Northeast and California. Each month we will continue to add providers as they enroll and are verified.

What types of providers is healthpons best suited to (primary care docs, dermatologists, cosmetic surgeons, etc.)?
The first provider registered was an ENT. We have pediatricians, surgeons, primary care, orthopedic, ENTs, family medicine and more. It is best suited to any provider willing to provide reasonable cash prices, willing to share content and to help people become more informed about what they do and how they are qualified to do it. Our focus is on transparency – and developing relationships.

How are you going to avoid the Groupon problem of too many vouchers sold, and providers subsequently becoming overrun with customers they are inadequately staffed to handle (typically resulting in poor customer service and no repeat patients)?
Our business model is not like Groupon. We make money primarily from any upgraded, subscription-based services or advertising.

All providers control the number of visits they can sell per service. We provide a guide to each provider as to what is recommended to sell. The consumer can see the provider’s availability prior to purchasing a visit. Also, we will monitor their sales and service comments to ensure quality and service is maintained.

I know there is more to share as Healthpons is developed with great depth. We have used multiple panels of providers and their office managers to preview our systems as we have developed. We took an idea we had and asked providers what they thought – what they wanted – then we asked our customers (patients) what they would like to get out of our platform. We bridged the concepts to bring doctors and patients together for an online network marketing experience to de-mystify medical services and pricing.

April 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 its three key properties – Billian’s HealthDATA, Porter Research and HITR.com. She is a regular contributor to a number of healthcare blogs, and currently manages the Technology Association of Georgia Health Society’s social media channels. You can find her on Twitter @SmyrnaGirl.

Breaking up with Your EMR is Hard to Do

In light of this week’s “holiday,” I thought I’d take a look at the current love/hate relationship the healthcare industry seems to have with electronic medical records and Meaningful Use.

EMRtweet2

Thanks are due to @mdrache and @EHRworkflow for their inspiration for the title of this week’s post: EMRtweet1

EMRtweet3

The nay sayers seem to have become especially vocal lately, which may be due in large part to the passing of time. Those that have implementations under their belt now feel qualified to talk about the efficacy of the solutions they selected. Negative EMR press may also have bubbled up to the service in light of the recent RAND report, which backpedaled on previous predictions of cost-savings associated with healthcare IT adoption. That study broke the ice, so to speak, and perhaps made providers more comfortable with voicing their discontent.

In any case, if current healthcare IT press is any indication, EMR technology currently on the market has often left providers dissatisfied for a number of reasons. No doubt this dissatisfaction will be a subject of many show-floor conversations at HIMSS in a few weeks. I wonder how EMR vendors are preparing their responses. What will be their top three talking points when it comes to EMR benefits? It seems Meaningful Use incentives have lost their luster, and in fact have left many providers disenchanted with healthcare IT in general.

John Lynn posted a very telling reader comment over at EMRandHIPAA.com from a provider who used his Meaningful Use malaise to create a new independent practice business model. Is this an indication that more providers may “revolt” against Meaningful Use and the trend towards hospital employment? If so, what will the private practice landscape look like in three to five years?

Just how easy is it for providers to truly “break up” with their EMRs? We’ve all read the multi-million-dollar rip-and-replace horror stories – talk about a bad breakup. And then there are the providers that stay in dysfunctional relationships with their EMRs because they can’t afford a new one, instead developing copious amounts of workarounds potentially at the expense of clinical care and accurate reimbursement.

As of last summer, KLAS reported that a whopping 50% of providers were looking to replace their ambulatory EMRs, compared to 30% in 2011. A recent Health Data Management webinar noted more than 30% of ALL new EMR purchases are made to replace an existing EMR.

To me, these numbers beg a number of questions. Were first- and perhaps even second-generation EMRs just not mature enough for providers’ needs? Did providers simply not do enough due diligence before making their purchases? Will these impending replacement EMR purchases stick? If you have updated EMR breakup statistics or a crystal ball, please send them my way.

February 13, 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 its three key properties – Billian’s HealthDATA, Porter Research and HITR.com. She is a regular contributor to a number of healthcare blogs, and currently manages the Technology Association of Georgia Health Society’s social media channels. You can find her on Twitter @SmyrnaGirl.

#eHealth100, Single EMR, EMR Adoption, and Wrong EMR Decision

You know what time it is if the post begins with a hashtag. That’s right. We’re taking a quick look at some of the interesting, insightful, fun, entertaining, beautiful or otherwise thought provoking tweets related to EMR and EHR.

We’ll lead off with a tweet nomination to the #eHealth100:


Yes, I was happy that Anneliz thought of me with this tweet nomination. Although, I must admit that I wasn’t sure what I was being nominated for, so I asked and got the following response about the goal of the #eHealth100


I appreciate being mentioned in this group. Considering the many people that make up the healthcare world, I just hope that each day I can make a small difference in people’s lives. It’s a beautiful thing when I can do that and provide for my family at the same time.


I love and hate the sarcasm in Dr. May’s tweet. I love the irony, but hate that it seems to be a major medical breakthrough.


I’m always looking for more numbers on EMR adoption. Although, then I realized that the article is from Venture Beat. Unfortunately, the people at Venture Beat don’t follow healthcare IT and especially EHR very well (they do follow other startups well). This can be seen in their reference to ZocDoc and Castlight as EHR companies likely to go public. They might go public, but they are definitely not EHR companies. I also love that they also have a quote saying that 90% of doctors don’t have an EMR which totally contradicts the CDC EMR adoption numbers they put at the beginning.

The long story short: 1. Don’t read Venture Beat for healthcare IT info. 2. We don’t really know how we’re doing with EHR adoption. We just know EHR adoption is on the rise.


I’ve sadly been predicting major EMR switching for a year or more. There are a number of reasons for this, but I’d say the biggest driver of EMR switching is thanks to the EHR incentive money and meaningful use.

December 30, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

“Fat Finger Syndrome” Not Just a Google Problem

In trying to keep things light this week, I’ve taken inspiration from two very different sources – NPR and Homer Simpson. A recent Morning Edition piece on “Fat Fingers Blamed for Mobile Ad Clicks” highlights the problem many smart phone users face -  large fingers on a small screen usually result in the occasional misspelling, accidental click on a field or image, or unintended dial.

The story concentrated on “Google’s launch of a new type of mobile ad that aims to combat the ‘fat finger’ problem. As the smart phone market grows, mobile ads have become more important to the tech giant, which makes most of its revenue through advertising.”

homeriphone

Listening to the piece, which started off with a hilarious sound bite from the Simpsons, made me wonder if EMR developers face this same type of problem when developing their software for mobile devices. What sort of consequences do providers face as a result of unintended clicks or incorrect data entry?

I polled a few friends who work in healthcare IT user experience (coincidentally, a topic that I heard come up quite often during the fall conference season), and they brought up numerous cases – some with dire consequences – of mistaken medication administration because of very similar patient names.

I also came across the ubiquitous drawback of using tablets in healthcare: “The iPad is difficult to type on, [one provider] complains, and his “fat fingers” struggle to navigate the screen,” according to a Kaiser Health News story last year.

But, providers, as they so often do, are creating workarounds. One family practice in particular has “introduced a stylus since some people occasionally suffer from ‘fat finger syndrome’ (some people just have an innate ability to miss the buttons in the questionnaire when they use their fingers).”

How have you, your practice or your colleagues dealt with pleasantly plump pads of the finger? Please share your anecdotes in the comments section below.

December 19, 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 its three key properties – Billian’s HealthDATA, Porter Research and HITR.com. She is a regular contributor to a number of healthcare blogs, and currently manages the Technology Association of Georgia Health Society’s social media channels. You can find her on Twitter @SmyrnaGirl.

Getting Personal with EMRs and Women’s Health

It’s that time of year again. Like my mother, I’ve taken to scheduling any sort of annual event around the time of my birthday. So, now my birthday cake is accompanied by a trip to get my emissions done, a jaunt to the tag office, and a visit to my primary care doctor for an annual physical and any other female-related health services I might need. (Timely, considering that October is also Breast Cancer Awareness Month.)

I tend not to schedule my well visits months in advance, and so was a bit apprehensive earlier in the week as I dialed in to get an appointment. I’ve read quite a few patient horror stories lately of appointments not being available for months due to lack of staff. Thankfully, this was not my experience. I was able to pick the date and time of my choosing, with the only insurance-related caveat being that I had to wait until one day after the date of my exam in 2011.

When I was at the doctor’s office last year, they were in the process of launching a patient portal. Digging around on their website while speaking with their receptionist, I noticed the portal is indeed available. The patient-centric portal offers online bill pay, appointment scheduling and pre-registration services and a personal health record. I’ll be interested to see if they mention its availability when I am seen in a few weeks. I’ll definitely ask who was involved with the implementation, and if they’re looking to Stage 2 Meaningful Use quotas when it comes to electronic patient engagement.

But enough about me. The reason I bring all this up is because the Journal of the American Medical Informatics Association recently made available research on “The effect of electronic medical record system sophistication on preventive healthcare for women.” A quick look at the abstract relates that 29.23% of providers (culled from those in the National Ambulatory Medical Care Survey from 2007-08) had no EMR system, 49.43% had minimal EMRs, 15.97% had basic EMRS, and 5.46% had fully functional EMRs.

“For breast examinations, pelvic examinations, pap tests, Chlamydia tests, cholesterol tests, mammograms, and bone mineral density tests, an EMR system increased the number of these tests and examinations,” according to the abstract. “Furthermore, the level of sophistication increased the number of breast examinations and pap, Chlamydia, cholesterol and BMD tests.”

The JAMIA’s point being that “the use of advanced EMR systems in obstetrics and gynecology was limited. Given the positive results of this study, specialists in women’s health should consider investing in more sophisticated systems.”

I’m going to play devil’s advocate here for a minute.

First of all, the fact that not even 5.5% of providers surveyed had a fully functional EMR is dismaying, but perhaps I don’t understand the underlying financial reasons for their lack of adoption. And the fact that the survey was taken more than four years ago could play a part. It would seem to me that there would be much to gain clinically and financially in having a fully function EMR especially in obstetrics, where women are often seen at a number of facilities throughout their pregnancies.

And finally, I have to take issue with the “positive results” the JAMIA concludes the study to have had. To me, “positive” connotes “successful,” so I wonder if there’s a hidden conflict of interest here. Increased sophistication of EMR systems would seem to equal more tests, according to the study, but no mention is made of if those tests lead to better outcomes (a win for patients) or higher reimbursements (a win for providers). I know we walk a fine line when talking about EMRs, tests and money, and that it often ends up being a chicken-and-egg situation, but it’s still a debate that needs to be had, especially in the area of women’s health.

October 18, 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 its three key properties – Billian’s HealthDATA, Porter Research and HITR.com. She is a regular contributor to a number of healthcare blogs, and currently manages the Technology Association of Georgia Health Society’s social media channels. You can find her on Twitter @SmyrnaGirl.

Primary Docs See Hope For Stronger Financials With EMR

Apparently, some primary care physicians are optimistic about the financial impact EMRs will have on their practice, according to a new survey.

Vendor Hello Health recently completed a survey of 100 practicing physicians without EMRs to discuss their attitudes about key business issues.  Not surprisingly, 37 percent of respondents said EMR adoption was their number one challenge at present; an equal percentage said that financial issues were their biggest worry.

Here’s what, to me, is the most interesting part of the study.  Among doctors for whom practice financial health was a primary concern, 51 percent felt that implementing an EMR would help solve their problems.

Their theory was that EMRs would help by improving coding and documentation to substantiate claims, as well as improving efficiencies and reducing costs.

Of doctors who didn’t think EMRs would help their financial situation, 46 percent felt that the systems would lead higher costs and overhead, and 15 percent felt productivity would decrease.

Now, I’m going to go all cynical on y’all.

I was pretty surprised to read that some doctors feel EMRs will actually improve their financial situation. Sure, improving coding and documentation itself is certainly a worthy financial goal.  The thing is, that’s not exactly what EMRs are designed to deliver.

As for improved efficiencies and reduced costs, well, I don’t find that very credible at all.  Not that some practices don’t achieve this goal,  but if the respondents  had anything near-term in mind they’re likely to be quite disappointed.

Realistically, if I wanted to invest in technology that improved my coding, I’d go with a computer-assisted coding or souped-up billing system. And I’d begin gunning my ICD-10 engines right away. Getting psyched about my pending EMR is nice, but probably setting oneself up for a letdown.

September 21, 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.

Survey Says Few Americans Want EMRs

I don’t know what to make of the following survey, which suggests that EMRs have a very long way to go before they’re accepted by the public.  Let’s lay out the numbers and see what you think.

According to new research from Xerox, only 26 percent of Americans would like to see their medical records digitized, despite otherwise having a love affair with all things digital.

Xerox, which hired Harris Interactive to do the study, did an online survey of 2,147 U.S. adults in May, asking them several questions related to their perceptions of EMRs. Forty percent said that digital medical records could deliver better and more efficient care, true, but 85 percent said they were concerned about the use of EMRs, Xerox reported.

Whatever is generating their resistance — and I’ll speculate on that in a minute — it’s not because they’ve never seen digital medicine. When asked how their providers recorded digital information during their last visit, 60 percent said data was entered into a tablet, laptop or in-room computer.

So, if Americans love online banking, Internet gaming and ordering from restaurants via the Web, why would medical records concern them so?

My guess is that the results we see here may be a result of the approach the researchers took.  If someone asked me: “Do you want something delicious and cool to eat during hot weather?” I’m pretty sure I’d say yes. On the other hand, if I was asked “Would you like to try this brand new ‘ice cream’ thing you’ve seen your neighbors eat?” I’m not as sure I’d be high on the idea.

If we’re going to forward the dialogue on EMRs with consumers, we’re going to have to help them understand why EMRs matter, and how they get the job done. Sure, the more esoteric stuff we discuss here might fly over their heads, but if you explained, for example, that EMRs can protect them from medical errors and and coordinate care better, they’ll get it.

August 31, 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.

Cognitive Dissonance and EMRs

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?

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.

EMRs Have Potential Role to Play in Curbing Global Contagion

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.

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 its three key properties – Billian’s HealthDATA, Porter Research and HITR.com. She is a regular contributor to a number of healthcare blogs, and currently manages the Technology Association of Georgia Health Society’s social media channels. You can find her on Twitter @SmyrnaGirl.