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Industry Tries To Steamroll Physician Complaints About EMR Impact On Patient Face Time

Posted on June 9, 2015 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.

Some doctors — and a goodly number of consumers, too — argue that the use of EMRs inevitably impairs the relationship between doctors and patients. After all, it’s just common sense that forcing a doctor to glue herself to the keyboard during an encounter undercuts that doctor’s ability to assess the patient, critics say.

Of course, EMR vendors don’t necessarily agree. And some researchers don’t share that view either. But having reviewed some comments by a firm studying physician EMR use, and the argument an EMR vendor made that screen-itis doesn’t worry docs, it seems to me that the “lack of face time” complaint remains an important one.

Consider how some analysts are approaching the issue. While admitting that one-third to one-half of the time doctors spend with patients is spent using an EMR, and that physicians have been complaining about this extensively over the past several years, doctors are at least using these systems more efficiently, reports James Avallone, Director of Physician Research, who spoke with EHRIntelligence.com.

What’s important is that doctors are getting adjusted to using EMRs, Avallone suggests:

Whether [time spent with EMRs] is too much or too little, it’s difficult for us to say from our perspective…It’s certainly something that physicians are getting used to as it becomes more ingrained in their day-to-day behaviors. They’ve had more time to streamline workflow and that’s something that we’re seeing in terms of how these devices are being used at the point of care.

Another attempt to minimize the impact of EMRs on patient encounters comes from ambulatory EMR vendor NueMD. In a recent blog post, the editor quoted a study suggesting that other issues were far more important to doctors:

According to a 2013 study published in Health Affairs, only 25.8 percent of physicians reported that EHRs were threatening the doctor-patient relationship. Administrative burdens like the ICD-10 transition and HIPAA compliance regulations, on the other hand, were noted by more than 41 percent of those surveyed.

It’s certainly true that doctors worry about HIPAA and ICD-10 compliance, and that they could threaten the patient relationship, but only to the extent that they affect the practice overall. Meanwhile, if one in four respondents to the Health Affairs study said that EMRs were a threat to patient relationships, that should be taken quite seriously.

Of course, both of the entities quoted in this story are entitled to their perspective. And yes, there are clearly benefits to physician use of EMRs, especially once they become adjusted to the interface and workflow.

But if this quick sample of opinions is any indication, the healthcare industry as a whole seems to be blowing past physicians’ (and patients’) well-grounded concerns about the role EMR documentation plays in patient visits.

Someday, a new form factor for EMRs will arise — maybe augmented or virtual reality encounters, for example — which will alleviate the eyes-on-the-screen problem. Until then, I’d submit, it’s best to tackle the issue head on, not brush it off.

More Details From Study: Health IT Could Cut Demand For Physicians

Posted on December 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Earlier, we wrote up the following study, which strongly suggests that health IT can boost physician productivity. But we didn’t include some of the details you’ll see below — and we thought they were important enough for a follow-up.

Much of the talk about health IT in physicians’ offices addresses the struggles doctors face when adopting new technologies, and the effort it takes to get productivity back to normal levels. But this study takes things a step further, asserting that if health IT was fully and widely implemented, it could reduce demand for physicians substantially.

The study, which originally appeared in Health Affairs, concluded that if health IT were fully implemented in 30 percent of community-based physicians’ offices, efficiency improvements would cut demand for physicians by 4 percent to 9 percent. What’s more, using health IT to delegate work to midlevel practitioners and from specialists to primary care docs could reduce demand for physicians by 6 percent to 12 percent, according to a story in Information Week.

Meanwhile, growing the amount of IT-enabled remote and asynchronous care could cut the volume of overall care that physicians provide could  have a big impact as well. Remote care could cut the percentage of care that physicians provide by 2 percent to 5 percent, and asynchronous care by 4 percent to  7 percent, Information Week reports.

And that isn’t all. If 70 percent of office-based docs adopted comprehensive IT support, including interoperable EMRs, clinical decision support, provider order entry and patient Web portals with secure messaging, the drop in demand for physician services would be twice as large, the Health Affairs study concluded.

That being said, the comprehensive use of health IT by even 30 percent of office-based doctors is at least five years and maybe as much as 15 years away, according to one of the study’s authors, Jonathan Weiner, professor of health policy and management at Johns Hopkins’ Bloomberg School of Public Health.

Study Suggests That Health IT Can Boost Doc Productivity

Posted on November 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

We’ve all heard stories about medical practices whose productivity crashed when they brought an EMR on board, for reasons that range from workflow problems to training gaps to problems with a wonky system.  But if the following study is right, there’s reason to hope that health IT will actually improve productivity over time, according to a story in Medical Practice Insider.

According to research published in journal Health Affairs, physicians with health IT on board will be able to serve about 8 percent to 15 percent more patients than they could without health IT tools. And in practices where doctors have higher levels of EMR or portal adoption, the spike could be higher, according to the research, whose team includes former national coordinator David Blumenthal.

Meanwhile, practices that adopt emerging technologies such as remote care could allow doctors to perform 5 to 10 percent of care to patients outside of the office visit, and 5 to 15 percent of care could be performed asynchronously, reports Medical Practice Insider.

Another study cited by the article, done by the National Center for Health Statistics, notes that EMRs can offer varied clinical and financial benefits, such as greater availability of patient records at the point of care. And adjunct tools like e-prescribing capabilities and the ability to retrieve lab results can save time and effort, the NCHS study concludes.

These studies are encouraging, but they don’t say much about how practices can manage the workflow problems that keep them from realizing these results. While I have little doubt that health IT can increase productivity in medical practices, it’s not going to happen quickly for most.  By all means, assume your medical practice will eventually leverage health IT successfully, but it won’t happen overnight.

P.S. In the mean time, take a look at this list of factors in creating satisfied EMR users. It might help you speed up the day when productivity climbs.

HIEs Unable To Keep Up With User Demands

Posted on August 7, 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

While HIEs are expanding their offerings to include analytic and care coordination functions useful for population health management, they aren’t doing it quickly enough to meet market demand, according to a piece in Information Week.

The IW story, which outlines the conclusions of a new report from Chilmark Research, notes that the focus of most HIEs is still on secure clinical messaging, which is not adequate for cross-enterprise care coordination. The Chilmark report estimates that queries of databases for patient info needed at the point of care account for just 2 percent to 10 percent of HIE transactions overall.

Information Week also drew attention to a study appearing in Health Affairs noting that the most common functions of the 119 operational public HIEs were transmitting lab results, clinical summaries and discharge summaries. While there’s been a large increase in the number of HIEs that can exchange Continuity of Care Documents, few EMRs can integrate the data components of CCDs in to structured fields, the Health Affairs piece noted.

The problem is particularly acute in ambulatory care. As Chilmark CEO John Moore told Information Week, most ambulatory EMRs haven’t been able to generate CCDs that other EMRs can consume or do queries using a record locator service. “The value that HIEs provide to the ambulatory sector, where 80 percent of care takes place, is pretty limited,” Moore told IW.

Still, despite their weaknesses, public HIEs continue to hold onto life. For example, as various industry stats have shown, hospital CIOs increasingly see participation in an HIE as a key initiative, if nothing else because Meaningful Use will eventually demand interoperability.

But as the Chilmark study emphasizes, HIEs have a long way to go before they’re making a major contribution to patient care. And getting enough momentum to address these problems seems elusive. All told, while HIEs are clearly an important movement, getting them to the point of true usefulness could take years more.

Health IT Doesn’t Save As Much As Hoped Due To Interoperability Failures

Posted on January 14, 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Does health IT actually save money for health organizations?  That’s a billion-dollar question — one which the whole Meaningful Use program rises or falls, I’d argue — but it still hasn’t been resolved. For what it’s worth, though,  here’s some thoughtful input on the subject.

According to a new study appearing in the journal Health Affairs, always the class act of the health policy game, health IT isn’t generating cost savings because of slow adoption and limited interoperabilityiHealthBeat reports. The research was conducted by the RAND Corporation.

Specifically, RAND researchers say, the productivity and cost benefits of health IT have been held back by:

* Slow adoption
* Reluctance of many clinicians to burn the midnight oil needed to truly master such systems
* Failure of the healthcare system as a whole to implement process changes needed to realize health IT system benefits

Another big issue is lack of interoperability between many health IT systems, the RAND researchers said. They note that previous predictions about health IT savings assumed that systems would be connected, thereby increasing efficiency.

To get savings from health IT, the U.S. healthcare industry needs to do the following, RAND says:

* Patients should be able to access their electronic health data and share those records with other health care providers
* Health care providers should be able to easily use health IT systems across different health care settings
* Health information stored in one IT system should be retrievable by health care providers that are part of other health care    systems
* Health IT systems should be set up to support — rather than hinder — the work of clinicians

No one of these points should come as a surprise, but given the stakes involved, it doesn’t hurt to hammer them home again. The whole interoperability “thing” isn’t going away…

The EHR Has Clothes … At Least Some of Them

Posted on July 10, 2012 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’ve been really falling in love with some of the content that the Health Affairs blog has been putting out there lately. A recent post titled “The EHR Has No Clothes” was no exception. In this incredibly thoughtful post by Barry Saver, he’s not afraid to start a discussion about points that many are afraid to talk about. I like that a lot. Although, I think the post also represents a couple ongoing trends I see in EHR perceptions.

Common EHR Problem 1 – I can’t tell you how many times I ask a doctor how they like their EHR and then they provide me some small facet of the EHR which annoys them. In Barry’s case it’s “Most screens do not show age, date of birth, or medical record number.” While we could delve into the particular feature that Barry mentions, that’s really not the point. The point is that far too often I see users of EMR systems fixating on one particular issue and ignoring the dozens of other items that are better than the paper world. It’s the proverbial throwing out the baby with the bath water.

No doubt I have a little Pollyanna in me. Although, I should be clear that I’m not suggesting that EHR problems shouldn’t be addressed. Please do hold EHR vendors accountable if their software needs changes. I am saying that I see far too many doctors and clinics that get so fixated on one problem that they ignore all the other good things that are possible. There are deal breaking EHR features and their are EHR annoyances that can be fixed. Make sure you know which one you are really dealing with when you see it.

As an interesting sidebar, this same fixation often happens in the EHR selection process. Although, in this case the person selecting the EHR often fixates on some particular feature (valuable or not). For example, they’ll say that they really love the login screen or background color. It’s amazing what little things can have such an influence on our decision making when they shouldn’t matter at all.

Common EHR Problem 2 – I’ll call this problem the mature feature problem. It turns out it’s a fallacy to assume that a mature EHR (ie. one that’s been around for a long time) has had time to fix all the problems. Here’s a short paragraph from the above linked post:

Approving 12 months of refills when I receive an electronic refill request typically takes a combination of 14 mouse movements, clicks, and keystrokes – as opposed to four if it were implemented efficiently. The list of items needlessly making it more difficult to provide efficient and effective care would cover many pages. These might seem like issues that could be present in version 1 of a system and then promptly fixed, but we currently have version 5.6.

I’ll save the discussion of mouse clicks and keystrokes for another post since it’s an important one. Instead, let’s focus on the idea that a mature EHR will have worked out all the issues with certain features. While this can definitely be true in the early development of EHR software, the opposite often comes into play as EHR software matures.

When an EHR begins its development life cycle it’s usually only saddled with a very specific task. In fact, you don’t have time to build all the features so you often have to make it really simple because of time constraints. Assuming this meets your workflow, it’s a great thing and you enjoy a wonderfully simple interface. Over time, features continue to be added to the interface. Plus, they have to start supporting all 50+ medical specialties that all have their own specific needs. Quickly, the beautiful EHR interface gets bloated to the point that it can do everything imaginable, but it does nothing really well.

Certainly, the best EHR software vendors know this and battle against it. Although, it really takes a battle to overcome this challenge.

What I find even more ironic is that Barry suggests Vista as the solution to his issues with EHR. At least he admits to never having used it other than the demo client on the web. Certainly Vista has its place in the EHR world and I love that it’s open source and benefiting from that innovation. Although, I think it’s crazy to think that a small doctor’s office is going to implement Vista. I’d love to see Barry do a write up after he adopts Vista.

Does the EHR have no clothes?
I think many EHR companies do have clothes on. I think the real problem is that we need to just stop shopping at the high end stores by the nude beach.

So, EMRs Do Reduce Tests Ordered? Partners Says Yes

Posted on April 16, 2012 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

About the same time last month, I brought your guys some unwelcome news – that physician access to electronic records perhaps doesn’t reduce the number of tests subsequently ordered, and hence doesn’t reduce healthcare costs as much as previously thought.

Except that maybe it does. At least that’s according to an article in Chicago Tribune that summarizes the findings of a study by Partners Healthcare, and a research letter published in the Archives of Internal Medicine (full text, PDF).

According to the study:
– It looked at health information exchange and test data between Mass. General Hospital and Brigham and Women’s over a 5 year period from Jan. 1, 1999 to Dec. 31, 2004.
– The study looked at 117,606 patients during this period. Of these, 346 patients had recent off-site tests, of which 44 were done prior to the HIE rollout.
– The study found that for patients with recent off-site tests, there was a 49% reduction in number of tests ordered.
In number terms, the number of tests ordered per person reduced from 7 in 1999 to 4 in 2004.
– There was however a slight increase in number of tests ordered for the population that didn’t have any prior testing done during the same time period – increasing from 5 per person to 6 per person.

These findings directly contradict the Health Affairs study that I mentioned earlier. The Chicago Tribune article has a little researchers-play-nice subsection at the end where the Health Affairs and Partners researchers try to interpret each other’s contradictory results.

If I may add my 0.02:
– Even though the Partners study follows a larger population of patients, the data that is used to calculate the reduction (346 and 44) is way too small
– The Health Affairs studied some 28,000 patients spread across 1,187 doctor’s offices, while the Partners study followed a larger population of patients at two huge Mass. hospitals that entered into a partnership with each other.

While this not directly discounting anything each group has found, I would think the HA study is more representative of what’s going on in different parts of the country, where doctors are using different (in capability/costs) EMRs and labs to get their results. In Partners case there may well be a tacit agreement on EMR brand, or even tacit trust between the labs/facilities that each hospital uses.

Very interesting though, and I’d really love to see what else comes out on EMR and healthcare costs.

Can Access to Prior Test Results Reduce Healthcare Costs?

Posted on March 12, 2012 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

Quick True or False question to brighten your day: If you switched doctors and your new doctor had access to your previous x-rays and lab tests, you’d probably not need to re-do your tests again.

If you answered true, great, you’re far more optimistic than what this study in Health Affairs reveals about doctors’ test-ordering propensities. According to the study (which BTW I haven’t fully read yet, having read only the abstract and the write-up about the study in the Health Affairs blog), doctors who had access to prior tests and images – tended to order more tests, not fewer, contrary to what one would expect.

One of the big reasons why EMRs are being so heavily touted from the government downwards is because they’re expected to reduce redundancies and save costs. Except that they might not.

Here’s a rundown of the study, based on what I read in the abstract as well as blog entry:
– The study analyzed 28,741 patient visits to 1,187 doctors offices in 2008.
– Access to computerized imaging results was associated with a 40-70% higher chance of a test being re-ordered. Access to such tests was not necessarily through an EHR.
– The presence of an EHR was not the key factor affecting the results found by the study. Rather it was the access to prior test results which was the determining factor. According to the blog post, “Physicians without such access ordered imaging in 12.9 percent of visits, while physicians with access ordered imaging in 18.0 percent of visits.”
– Also according to the blog, specialists tended to order additional imaging tests compared with primary care physicians. There were also gender differences with women receiving more tests than men.
– It’s not clear why. The blog quotes a researcher as surmising that perhaps if you make something easier to do, people will tend to do them more often, presumably referring to the ease with which a test can viewed, and later ordered from an EHR.

Of course I’m interested in knowing more about what’s going on and more importantly why.

– The finding about specialists might even make sense if the study had delved into how sick the population visiting the specialists was. Specialists typically see patients after they’ve been seen by a PCP, and maybe they’re seeing a sicker population on average.

– I also want to know more about the quality of images and how easily they can be accessed by the physicians across various. If my hospital or practice uses Vendor A’s EMR and I’ve been allowed to view Patient B’s records on Vendor X’s EHR, maybe I will just order a new test to get the same data into my own system.

– I’m also wondering what the insurance company’s take on all this is. I’ve not had much experience with imaging and tests and the like, touch wood, so this is a genuine doubt, no matter how stupid it sounds to you readers. I get a test done today, and a month later a different physician orders the same test, will my insurance company refuse to cough up for my second test?

Interesting study, nevertheless. Go check it out here or here.