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Healthcare Needs Clinician Data Experts

Posted on November 2, 2016 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.

This week I read an interesting article by a physician about the huge challenges clinicians face coping with unthinkably large clinical data sets — and what we should do about it. The doctor who wrote the article argues for the creation of a next-gen clinician/health IT hybrid expert that will bridge the gaps between technology and medicine.

In the article, the doctor noted that while he could conceivably answer any question he had about his patients using big data, he would have to tame literally billions of data rows to do so.

Right now, logs of all EHR activity are dumped into large databases every day, notes Alvin Rajkomar, MD. In theory, clinicians can access the data, but in reality most of the analysis and taming of data is done by report writers. The problem is, the HIT staff compiling reports don’t have the clinical context they need to sort such data adequately, he says:

“Clinical data is complex and contextual,” he writes. “[For example,] a heart rate may be listed under the formal vital sign table or under nursing documentation, where it is listed as a pulse. A report writer without clinical background may not appreciate that a request for heart rate should actually include data from both tables.“

Frustrated with the limitations of this process, Rajkomar decided to take the EHR database problem on. He went through an intense training process including 24 hours of in–person classes, a four-hour project and four hours of supervised training to obtain the skills needed to work with large clinical databases. In other words, he jumped right in the middle of the game.

Even having a trained physician in the mix isn’t enough, he argues. Ultimately, understanding such data calls for developing a multidisciplinary team. Clinicians need each others’ perspectives on the masses of data coming in, which include not only EHR data but also sensor, app and patient record outcomes. Moreover, a clinician data analyst is likely to be more comfortable than traditional IT staffers when working with nurses, pharmacists or laboratory technicians, he suggests.

Still, having even a single clinician in the mix can have a major impact, Rajkomar argues. He contends that the healthcare industry needs to create more people like him, a role he calls “clinician-data translator.” The skills needed by this translator would include expertise in clinical systems, the ability to extract data from large warehouses and deep understanding of how to rigorously analyze large data sets.

Not only would such a specialist help with data analysis, and help to determine where to apply novel  algorithms, they could also help other clinicians decide which questions are worth investigating further in the first place. What’s more, clinician data scientists would be well-equipped to integrate data-gathering activities into workflows, he points out.

The thing is, there aren’t any well-marked pathways to becoming a clinician data scientist, with most data science degrees offering training that doesn’t focus on a particular domain. But if you believe Rajkomar – and I do – finding clinicians who want to be data scientists makes a lot of sense for health systems and clinics. While their will always be a role for health IT experts with purely technical training, we need clinicians who will work alongside them and guide their decisions.

No, The Market Can’t Solve Health Data Interoperability Problems

Posted on July 6, 2016 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.

I seldom disagree with John Halamka, whose commentary on HIT generally strikes me as measured, sensible and well-grounded. But this time, Dr. Halamka, I’m afraid we’ll have to agree to disagree.

Dr. Halamka, chief information officer of Beth Israel Deaconess Medical Center and co-chair of the ONC’s Health IT Standards Committee, recently told Healthcare IT News that it’s time for ONC and other federal regulators to stop trying to regulate health data interoperability into existence.

“It’s time to return the agenda to the private sector in the clinician’s guide vendors reduce the products and services they want,” Halamka said. “We’re on the cusp of real breakthroughs in EHR usability and interoperability based on the new incentives for outcomes suggested by MACRA and MIPS. {T}he worst thing we could do it this time is to co-opt the private sector agenda more prescriptive regulations but EHR functionality, usability and quality measurement.”

Government regs could backfire

Don’t get me wrong — I certainly appreciate the sentiment. Government regulation of a dynamic goal like interoperability could certainly backfire spectacularly, if for no other reason than that technology evolves far more quickly than policy. Regulations could easily set approaches to interoperability in stone that become outmoded far too quickly.

Not only that, I sympathize with Halamka’s desire to let independent clinical organizations come together to figure out what their priorities are for health data sharing. Even if regulators hire the best, most insightful clinicians on the planet, they still won’t have quite the same perspective as those still working on the front lines every day. Hospitals and medical professionals are in a much better position to identify what data should be shared, how it should be shared and most importantly what they can accomplish with this data.

Nonetheless, it’s worth asking what the “private sector agenda” that Halamka cites is, actually. Is he referring to the goals of health IT vendors? Hospitals? Medical practices? Health plans? The dozens of standards and interoperability organization that exist, ranging from HL7 and FHIR to the CommonWell Health Alliance? CHIME? HIMSS? HIEs? To me, it looks like the private sector agenda is to avoid having one. At best, we might achieve the United Nations version of unity as an industry, but like that body it would be interesting but toothless.

Patients ready to snap

After many years of thought, I have come to believe that healthcare interoperability is far too important to leave to the undisciplined forces of the market. As things stand, patients like me are deeply affected by the inefficiencies and mistakes bred by the healthcare industry’ lack of interoperability — and we’re getting pretty tired of it. And readers, I guarantee that anyone who taps the healthcare system as frequently as I do feels the same way. We are on the verge of rebellion. Every time someone tells me they can’t get my records from a sister facility, we’re ready to snap.

So do I believe that government regulation is a wonderful thing? Certainly not. But after watching the HIT industry for about 20 years on health data sharing, I think it’s time for some central body to impose order on this chaos. And in such a fractured market as ours, no voluntary organization is going to have the clout to do so.

Sure, I’d love to think that providers could pressure vendors into coming up with solutions to this problem, but if they haven’t been able to do so yet, after spending a small nation’s GNP on EMRs, I doubt it’s going to happen. Rather than fighting it, let’s work together with the government and regulatory agencies to create a minimal data interoperability set everyone can live with. Any other way leads to madness.

Are EMRs Getting Worse Or Doctors Getting Smarter?

Posted on August 20, 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.

I know it sounds crazy — it’s hard to imagine doctors being more annoyed with EMRs than they already are — but according to one study that’s just what’s happening.

A newly-published study by the American Medical Association and the American College of Physicians’ AmericanEHR division suggests that doctors like the current crop of EMRs less than ever.

About half of study respondents said that their EMR was having a negative impact on costs, efficiency or productivity, the groups reported. Only 22% said they were satisfied with their EMR, and a scant 12% said they were “very satisfied.”

Doctors’ happiness with their EMRs has dropped substantially since five years ago, when 39% reported being satisfied and 22% said they were very satisfied, according to a prior study by AmericanEHR.  In other words, nearly 4 out of 10 doctors surveyed seem to have been content with what they had. But conditions have clearly changed.

The reasons for this are unlikely to be the result of mere peevishness. After all, with EMRs being a reality of doing business today, it seems unlikely that physicians would simply revert into sulking. Actually, my own unofficial survey — of several docs I’ve actually seen as a patient — suggests that most have gone through their stages of grief and decided that EMRs aren’t unholy. (My PCP said it best: “You get used to them, then they’re not so bad.”)

Instead, I’d argue, something good is actually happening, though it may not look that way on the surface. Having adapted to the need to use EMRs, physicians are engaging with them deeply, and beginning to expect more from them than a kludgy interface slapped on a slow database can provide.

Some are actually proposing that EMRs go beyond traditional medical record paradigm, something I see as an exciting development. For example, Dr. Arlen Meyers, CEO of the Society of Physician Entrepreneurs, argues that it’s time to “unbundle and re-engineer the care processes model” by introducing new templates into EMRs. In fact, he’s a fan of rethinking the hallowed SOAP (symptoms, objective findings, assessment and plan) approach to patient notes:

Given how things are changing, it might be time to give the pink slip to SOAP. The main problems are that 1) the model does not prioritize information by levels of urgency, 2) it does not provide decision support when it comes to how one disease affects the other or how one medicine affects another, and 3) it does not add efficiencies to taking care of increasingly complex patients.

And Meyers is not the only one. In fact, a recent paper published in JAMA Internal Medicine suggests that a new format flipping the elements of the SOAP note and reordering them as APSO (assessment, plan, subjective, objective) works well in the EMR age.

According to a 2010 study detailed in the paper, APSO notes were fairly successful at the University of Colorado ambulatory clinics. The study, which looked at APSO use in 13 clinics, found that 73% of participants were “satisfied” or “very satisfied” with the new format, and 75% “preferred” or “strongly preferred” reading APSO notes.

I’m betting that physicians will only be satisfied with EMRs again when EMRs are reshaped to embrace new ways of working. Since new workflow demands are generated by using EMRs, in turn, this cycle may never end. But that’s a good thing. If physicians are engaged enough with their EMRs to propose new ways of working, it will benefit everyone.

Adapting Hospital Records to the Needs of Transgender People

Posted on July 13, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

More than just about any other institution, hospitals and clinics have to deal with the unexpected. People with the most unusual characteristics and problems drop in all the time. But electronic records, being formal documentation, like regularity. The clash between diversity and computerization explodes into view when a transgender or gender-queer person walks in.

I have written about the strains that transgender people put on an EHR earlier as part of my family’s encounter with the medical system. Recently I got a chance to talk with a leader who has taken some of the necessary steps to fix systems: Scott MacDonald, MD, working in the health system of University of California at Davis.

A thrust to improve UC Davis’s handling of LGBT clients preceded Dr. MacDonald’s arrival. A group of staff and clinicians interested in providing better care to LGBT people decided to take steps to address the needs in that area. The institution made an ethical commitment to reducing disparities in care. The group recognized that the information in the record was deficient–they often didn’t even know who identified as LGBT.

The first step in this information gathering is training health providers to ask for the information in ways that are sensitive to patients’ feelings, and to become comfortable with it. The next step is deciding what to do with that information, and the third is figuring out how to store it in a structured way.

As MacDonald says, “The first priority is to train providers to understand why this data collection is important, explaining that they cannot care for a person whose life situation they don’t understand. Research (especially for reducing disparities) is a close second priority. An electronic means to capture the data needs to be created along with these efforts. Once the data is available in a formal, structured way, we can encourage and train clinicians to ask the pertinent questions and respond to the information sensitively.”

When MacDonald joined the organization, he brought technical expertise with working on disparities in ethnicity and language. He started two surveys: one of the patient population and another of the staff.

The patient survey showed that for the most part, patients were glad to be asked about their sexual orientation (which is different from sexual behavior, although related). They were particularly open to the question if their primary care provider was the one holding the discussion. Naturally, some expressed privacy concerns and wondered who might have access to the information once it was recorded.

Health care providers also showed a willingness to learn more about LGBT issues and be listed in the UC Davis registry as an LGBT-welcoming provider. Over time, without an explicit mandate from leadership, the information collected on the sexual preference of patients increased. UC Davis also provided resources for training in LGBT issues via a web site.

Before starting, UC Davis interviewed the clients of a local clinic specializing in gender issues, in order to flesh out their understanding of patient needs and sensitivities.

Now we get to the heart of the IT issues. Any record system used by a health care institution needs at least the following to handle transgender and gender non-conforming patients:

  • A way to list their preferred name and gender, along with the name and gender that appear on their insurance cards and other official documents. Transitions can take years, and patients often have insurance with the old name and gender long after they have made the determination to be known in a new way. Gender can also be a fluid and evolving concept for some patients.

  • Ways to record the factors that affect gender, such as what surgeries they have had for gender dysphoria and what hormones they are taking. Someone who identifies as male may still need to have a regular Pap smear. A male-to-female transgender person may have a very different normal range on a blood test from someone born female (cis-female).

UC Davis had licensed an Epic EHR, but at that time Epic had only a few suggestions to offer. For instance, they suggested adding a special flag for transgender patients, but this would be too limited a way of handling the range of gender issues encountered, and would not provide adequate clinical information. UC Davis thus launched into a series of customizations, which Epic in turn compiled into an implementation guide that has been used by other customers.

The goal at UC Davis was to make it easy for patients to enter data at in the privacy of their homes through Epic’s patient portal. The interviews at the partner clinic had showed that many were comfortable providing information this way that many were comfortable providing information this way. Besides asking for assigned sex at birth, click-buttons in the portal’s web page offer common choices for current gender identity and sexual orientation. The patient could also enter free-text comments if the predefined choices didn’t capture their identity.

The same information could be entered by clinicians as well. People viewing the record could not tell whether the gender information was entered by a clinician or directly by the patient (although on the back-end, the system preserves the provenance of the information). MacDonald said that the source of the information was ultimately the patient, so it doesn’t really matter who entered it.

What’s important is that the gender-related information, formerly stuffed into free-form text somewhere in the record, was now stored in a structured format. This allows UC Davis to fulfill its mandate to track how it is addressing disparities in care. In the future, such information may also feed into clinical decision support tools.

The gender information is not displayed prominently, but is available to all staff who have access to patient records and seek it our for purposes of patientcare. It is protected by the usual information security measures in place at UC Davis. The information is of greatest use to the primary care provider, but is also used by in-patient nurses and special departments dealing with transgender issues.

The patient’s preferred name was easier to handle. Epic already allows records to distinguish between the official name–used for legal and insurance purposes–and the preferred name. The record offers several descriptors that explain what the preferred name is, such as a nickname or alias. To this list of descriptors, UC Davis added an option applicable to transgender patients.

The remaining missing information is the status of a patient during and after transition. A record can’t yet record birth sex in a separate field from gender identity. It can capture sex as cis-male or trans-man, but that doesn’t gracefully account for the combinatorics of birth sex, gender identity, legal sex, and so on. Transition-specific surgeries and hormone therapy can be captured as a part of surgical history and the medication list, but there is no standard way to record organ inventory. Those things are still listed in free-form text.

However, Epic is looking at ways to adapt its software at the deep level to show this diversity of status. This is something all vendors need to do, because more and more people of all ages are identifying as transgender or non-conformaing as the public gets used to the idea that this kind of identity is within the range of normal. The needs of the population are complex and urgent, so the faster we fix the records, the better will be the care we provide.

Adding “Social Documentation” To EMRs

Posted on March 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.

While EMRs store key clinical information, a vast amount of clinical communication goes on outside the system, via instant message, text, e-mail, fax, phone and social media.

Most health IT managers don’t concern themselves much with the chatter outside the EMR, other than to see that — where possible — it takes place in a secure manner. But according to John Halamka, MD, chief information officer for Beth Israel Deaconess Medical Center, this communication is too important to be ignored.

Rather than let these conversations stream on without ever entering the EMR, he argues that it’s time to begin mining these discussions and integrating them into the EMR.  As he sees it, smart devices, the cloud, instant messaging, SaaS and social networking should be combined to create what he calls “social documentation” for healthcare.

Just what is social documentation?  Here’s his definition:

I define “social documentation” as team authored care plans, annotated event descriptions (ranging from acknowledging a test result to writing about the patient’s treatment progress), and process documentation (orders, alerts/reminders) sufficient to support care coordination, compliance/regulatory requirements, and billing.

So, in social documentation, the various channels clinicians are already using to connect with each other go from ancillary information to key ingredients in a team approach to care. But Halamka breaks it down further. Social documentation, he says:

*Incorporates data input from multiple team members, reducing the documentation burden for each participant
*Eliminates redundant entry of the same information by different caregivers (nurse, pcp, specialist, resident, social worker)
*Supports Wikipedia like summaries (jointly authored statement of history, plans, and decision making)
*Supports Facebook/Twitter like updates i.e. “Patient developed a fever, ordered workup, will start antibiotics”
*Incorporates data already present in the EHR such as orders and results without having to re-describe them in narrative form

I don’t know about you, but to me this makes enormous sense. As Halamka himself concedes, creating a new modular architecture that can support such documents might be “burdensome” but it’s still something to bear in mind as we move forward.

Beth Israel Deaconess Asking Patients To Opt In To HIE Data Sharing

Posted on July 9, 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.

One of the less-obvious, but critical, issues in rolling out an HIE is how management handles patient consent for widespread use of the data.  Providers who don’t ask for detailed permissions as to which HIE partners may use patient data when may someday find themselves at the barrel end of a high-caliber lawsuit.

To avoid such entanglements, Beth Israel Deaconess Medical Center (BIDMC) CIO John Halamka, MD has announced that it will require its 1,800 affiliated ambulatory care providers get patient opt-in for data sharing among clinicians on their case.  The permission slip Halamka wants patients to sign will cover not only care within BIDMC but also care provided by outside clinicians.

The process BIDMC has developed is quite interesting, both in what it demands from clinicians and how the IT department is involved:

*  Doctors who have a need to see patient info for treatment, payment or operations can electronically request a view from a community practice.  To make the query, doctors hit what BIDMC is calling a “magic button” which works as follows (info below from Halamka’s blog):

1.  The clinician clicks on a button inside their EHR.   This click launches a query containing Name, Gender, Date of Birth, and Zip Code to a responding EHR.    The physician does not need to respecify the patient or log in to a separate portal since the patient identity information and security credentials are sent from the querying EHR automatically.
2.  The responding EHR checks the security, looks up the patient, and responds with a medical record number if the patient is found.
3.  The querying EHR sends a new query incorporating the returned medical record number.
4.  The responding EHR launches a web-page which displays clinical data for that medical record number.
5.  All transactions are audited in the responding EHRs.

* Doctors can only get data for patients shared between the two organizations

* All requests will be audited

* There will be no “break the glass” feature allowing clinicians to override patient preferences

* Patients can opt-in later if they choose not to now

The audit aspect of this is especially interesting.   How often? By whom? What protocols are in place to respond when something seems to be out of order?

But I must say the whole thing is intriguing.  It seems to me that BIDMC is making the right choice, but anything involving consumers has a bunch of fail points that don’t pop up at first.  I wonder how consumers will feel about this plan six to twelve month after it’s enacted.  Much to learn here.

When Physicians Own Practice, EMR Implementation Feels Tougher

Posted on January 30, 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.

Here’s an EMR adoption study which interested me largely because it runs counter to what I would have predicted.  The study, which surveyed physicians pre- and post- EMR implementation, found that doctors who owned a stake in their practice found their rollout to be tougher than physicians who didn’t have a stake.

I don’t know about you, but I would have assumed that the folks with more control — the owners — would have found it easier than those who have to adapt to the decisions others make.  But it seems that physician-owners simply feel the pain of change more acutely.

To conduct the study, which was published last week in the Journal of the American Medical Informatics Association,  researchers surveyed 156 physicians working with the Massachusetts eHealth Collaborative.  The surveys included a pre-implementation questionnaire  in 2005 and a post-implementation questionnaire in 2009.

Thirty-five percent of doctors who responded reported that implementation was very difficult, 54 percent said it was somewhat difficult and 12 percent not difficult. Those numbers square pretty well with what I’ve seen elsewhere. The twist here was that 38 percent of physicians with full or partial ownership stakes in their practices voted “very difficult,” versus 27 percent of non-owners. That surprised me. After all, aren’t most of the complaints coming from doctors who try to use the new systems?

According to Marshall Fleurant, MD, one of the study’s authors, the owners “probably experienced more underlying challenges associated with EHR implementation and workflow transformation” given their broader operational responsibilities.

While this study is interesting, it’s hardly the last word. Teasing out just which factors predict how doctors will react to EMR implementation, much less what it takes to support them, is still a new science.  But it never hurts to bear in mind that physicians making critical management decisions get support, too.

One Doctor’s View of ePrescribing and Meaningful Use Incentives and Penalties

Posted on January 20, 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 came upon this comment from Kay Kirchler, MD in regards to the ePrescribing penalties and other government incentive money for health IT. You’ll have to overlook the poor grammar and abbreviations, but I wonder how many other doctors feel the way Dr. Kirchler does.

who made all these rules and why are we just lying down and taking it? the arbitrary requirement for “10 escribes ” by june 30th or “penelty” when our emr ( we have had emr for >>10 yrs) will not escribe due to delay in “retro-fitting ” our emr instead of spending yet another fortune for a new “government approved ” version. the requirement to print out visit note to be available w/i 3 days rule .. rediculous. pts dont want it , not going to pick it up, costly and opens door for pts info to be floating out in parking lots, garbage cans etc .. i could go on for days. i spend more time loading info in emr ( much more w “meaningless use” than i do taking care of the patient .why are we not organizing to stand up and fight this power grab !!!!

The line that gets me is the one where he says that he spends more time loading data into the EMR than he spends with the patient. As a patient, the idea of this just makes me cringe. However, it’s a reality for many.

The other part that is quite interesting is that there really haven’t been many physician voices in all of this. There’s definitely not been any #OccupyMeaningfulUse protests happening by doctors. The closest thing I’ve seen to doctors rising up against Meaningful Use and other government programs for health IT has been at medical association conferences where doctors have gotten quite worked up. However, the message rarely leaves the medical conference. Plus, the majority of doctors in the room just shake their head, but don’t do anything after that.

I imagine many doctors look at it and see EHR software as the inevitable.

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?