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Do Primary Care Physicians Have A Bigger Stake in EMR Adoption?

Posted on April 30, 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.

Here’s a theory I’ve been working on — one which I’ve come to doubt — but I’ll put it out there anyway and see what readers think. As I’ve watched the slow, painful process of physician EMR adoption, I’ve had the sense that primary care physicians were under the most pressure to move ahead and were likely to lead the parade.

Sure, everyone has their eye on HITECH incentives, but primary care doctors have even more to worry about. For starters, they have a more challenging  population management task at hand.  Now, they’re under even more pressure, being expected to provide a “medical home” for patients, do more monitoring of their condition, coordinate specialist care and check up on patients’ compliance with preventive health measures.

In theory, PCPs can do such monitoring on paper, and some actually do.  But one can only assume that it’d be easier to manage these increasing levels of responsibility  — and to provide the extensive quality data health plans demand — if they get an EMR in place quickly.

Sure, I hear plenty about specialist EMR adoption, and technology for specific specialty niches, but my gut feeling has remained that primary care doctors have the most to lose if they don’t move quickly.

However, search though I might, I can’t find any anecdotal or statistical data to support my conclusion, so maybe I’m way off here.  Folks, what are you hearing?  Are primary care doctors adopting EMRs at a faster rate than their specialist colleagues, or are specialists picking up the ball at a similar pace?

Why Aren’t Pharmas, Health Plans Paying for EMRs?

Posted on April 4, 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.

The following questions have been bothering me, and I don’t have answers. Maybe readers will be able to fill me in.

As far as I know, pharmaceutical companies haven’t been subsidizing or providing EMR software to medical practices, though I can’t imagine a better opportunity to a) form even closer ties with medical practices and b) get their message in front of physicians every day.

Attorneys, if you’re reading these, feel free to chime in and let me know if I’m not up to date; I realize laws governing donations to physicians are a moving target. But assuming it’s  still legal, I can’t see why pharmas haven’t jumped all over this idea.

I don’t know enough about pharma marketing costs to hazard a guess on what this strategy would generate financially, but I can only imagine it would be a winner.

Another stumper: why aren’t health plans investing in EMRs for their physicians on a large scale?

Not only would EMRs potentially improve efficiency and lower costs, they’d also give the plans an opportunity to build in real-time claims processing. That’s a huge win for both doctors and plans. From what I’ve read, health plans could save billions in paper transaction costs alone if they could use EMRs as a platform to connect processing directly.

As I see it, both of these industries have even better reasons to push EMR adoption than hospitals. Sure, hospitals need to connect with doctors, build loyalty and coordinate care, but the financial upside seems much larger — and more measurable — for pharmas and health plans.

So, this one’s on you, readers.  Why aren’t these other stakeholders getting into the game?  Hell, why aren’t employers taking a stand? (PHR efforts like Dossia don’t count in my view.)  Am I missing something here?

The ARRA EMR Staffing Challenge

Posted on October 26, 2009 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.

I came across a really interesting take on the challenge of ensuring that there are enough qualified EMR staff. Here’s a portion of the blog post:

What happens to you when you call asking to buy an EMR, and have it implemented by 2010?

-Will you be told that the vendor doesn’t have the resources, and that you’ll have to wait?
-Or will the vendor sell the EMR, and worry about the implementation later?
-And if the latter is the case, what will that vendor do to get you implemented?

Most vendors know they will have to hire new employees to fill the need for this bolus of implementations that they know is coming–and they also know that these employees will be new, green and inexperienced. Perhaps yours might even be their first implementation. Yes, they may have “supervision” from a more experienced implementer in the organization, but the bottom line is that they will de facto have less experience than they might otherwise.

Not a good thing…but it gets worse.

Now ask yourself where will these new EMR implementation experts come from?

Some will be young staff, perhaps fresh from college looking for their first job. Others may be transitioning from other industries (perhaps even with some implementation experience outside of healthcare). Others might be clinicians looking to transition to IT.

But all of these folks lack the healthcare IT expertise that will be critical to a successful EMR implementation.

It would be ideal if a vendor could hire experienced EMR implementation folks, but where would such individuals be found?

Hospitals, physician groups & practices – why, perhaps even your staff!

You should go and read the rest of the blog post for an interesting discussion of how you can retain your qualified EMR and HIT staff despite the high demand for such qualified people.

If you find this subject interesting, you should also go and check out this take on the regional extension centers timeframes to support EMR implementations and also this really interesting take on the EMR training backlog.

Simple EMRs and the EMR Backlog

Posted on August 19, 2009 I Written By

The following is from XLEMR. In this Newsletter, Ryan Ricks argues that simple EMRs have many advantages over complex EMRs. They are simpler to learn and install. This may be important if you are going to get your first year HITECH Bonus (if you don’t get it in 2011, you lose it). In my opinion, it is very important that EMRs like this can be certified so Physicians have choice. As long as you can use them in a “meaningful” way, they should be certified. For my definition of “meaningful” see What is “Meaningful Use”, What EMRs should be “Certified” and Who should do the Certifying from July 27, 2009.

This is an excerpt from Mr. Ricks’ post.

Once preliminary certification begins in October, EHR demand should surge. Although the market is currently slow, many vendors have installation backlogs. Preliminary certification may cause those backlogs to increase. Physicians who are in the “wait and see” mode will need to make a decision quickly. Waiting could result in long delays that may jeopardize the ability to qualify for the first year of reimbursements. One alternative is to purchase a simple system. Simple systems take much less time to install, so backlogs are not a problem. Simple systems are also easier to learn, meaning you do not use as much valuable time for training instead of seeing patients. Finally, simple systems are easy to use, giving you more time to qualify for meaningful use. Be sure to ask any EHR vendor if they have any backlogs, and how long it takes to implement their system. Their answer will tell you if their system is simple.

Has anyone seen this backlog? How long do you have to wait?

EMRs, Small Business and Universal Coverage

Posted on July 28, 2009 I Written By

I turned on the radio on Monday and they were talking about Healthcare again. Universal coverage, the August recess, the “blue dog” democrats.

I keep thinking about how EMRs fit into all of this. Obama thinks that EMRs are going to make care better, more efficient and less costly. I think he is right about the first two (if we install EMRs that are usable and bring value to doctors and patients), but not necessarily about the third. EMRs may not reduce costs!

As Obama takes our economy (and our healthcare system) away from the small business model to the big government/big business model, I wonder how EMRs fit into all this. Investing in an EMR is a big deal for most physicians because we are a small business that provides medical care. Spending hundreds of thousands of dollars on an EMR which may not bring return on investment (ROI) while potentially reducing our productivity is a big risk. At the same time, if reimbursement are reduced or the system becomes Universal, the stakes are higher and the risks are greater.

Everyone (individuals and small business) is struggling with our current economy. Small businesses are at risk (many are closing their doors). Physicians are working hard to pay the bills, make payroll and have a little left over to take home to the family. The EMR issue has to be handled correctly or it could have dramatic effects on our healthcare system. The EMRs have to be effective and efficient. Doctors have to like them and be satisfied with their utility and performance. EMRs have to help us take care of patients more effectively and efficiently. Anything less than this throws more sand into the cogs of the healthcare machinery and amplifies the risks of all the other changes occurring at this time.