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Study Suggests That Health IT Can Boost Doc Productivity

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.

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 @annezieger on Twitter.

Three Tips For EHR Transitions

Moving a medical practice from paper to an EHR is no picnic.  Staff and physicians both may find the process difficult, and the changes they have to make to be threatening. But there are approaches you can take which can make the process easier.  Here’s a nice triad of suggestions from EHR implementation manager Amanda Guerrero:

* Make workflow changes gradual:

Too often, medical practices assume that they can implement an EHR without making major changes to their workflow.  The reality is, however, that many processes which worked fine on paper don’t work when you switch to using EHRs, Guerrero notes. So how do you go about making changes without upsetting and confusing staff and clinicians?  The idea, she says, is to make sure changes happen gradually. Giving people time to adapt to changes helps a lot with staff morale. (It doesn’t hurt to explain how the changes will benefit both staff and patients, either.)

Ask for feedback:

Bearing in mind that changes to workflow will have to be made, how do you choose which changes come first? One way, Guerrero says, is to ask the people who are using the EHR which processes are slowing things down the most.  Be sure, she recommends, to include doctors, nurses, front desk and even billing staff in collecting feedback — after all, virtually any part of the practice can be affected by the EHR.  Once you’ve figured out which areas are the most troublesome, arrange them in order of importance so you can take them on in the most effective manner.

Educate patients:

Now that Meaningful Use has pushed practices into making patient health data available to them, it’s time to encourage them to use it. That being said, patients may be overwhelmed by the amount of data being presented, especially when interpreting lab results, Guerrero suggests.  To reduce the impact of this change on patients, and avoid confusion, make sure you help them understand what they’re looking at and how it can help them improve their healthy, she says. And make sure let patients know you’re available to help answer questions.

May 20, 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 @annezieger on Twitter.

Doctor Describes 15+- Year EMR Integration Project

Wouldn’t it be great if you rolled your EMR and, bam, all of the problems you hoped to solve were solved, just like that?  Sure, but in most cases the technical rollout will do little to solve workflow problems unless you have them analyzed in advance, according to one doctor who’s taken part in a long, slow rollout. Here’s a quick overview of his organization’s progress: see what you think.

Going live is a far cry from having truly adopted an EMR,  and getting to adoption is a very long, drawn-out process, said Dr. Fred M. Kusumoto, who spoke at a recent meeting of the Heart Rhythm Society.

Dr. Kusumoto, who’s with the Mayo Clinic Jacksonville Electrophysiology and Pacing Services, conceded that EMRs can help smooth communication between systems. The thing is, he noted, integrating systems won’t happen over night. After all, the workflow of doing integration is very complex, so much so that years hardly suffice.  His organization began serving as “guinea pig” for its EMR vendor in 1996 and will as of 2013, will have one database using structured data, he said.

So, the million-dollar question is this: Has all of this effort been worthwhile?  Dr. Kusumoto actually didn’t say, if the CMIO article I reviewed is accurate.  Interesting. But he’s clearly learned a great deal, regardless of whether his rollout works out for Mayo. Here’s some of his suggestions on how to improve returns from your maturing EMR:

*  Make sure all stakeholders are involved as the EMR migration, including administrators and IT staffers.

* Bear in mind that EMR rollouts are at their most flexible in the first few years, so don’t miss your chance to get involved early.

* EMR implementations (typically) involve a scanning phase where the institution captures written records and plans for turning the records into structured data. Make sure you leave enough time to do this right.

May 11, 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 @annezieger on Twitter.

When Physicians Own Practice, EMR Implementation Feels Tougher

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.

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 @annezieger on Twitter.

More On EHR Usability: Let Doctors Decide

Here’s worthwhile some observations on how to drive improvements in EHR usability from Evan Steele, CEO of EMR, practice management and PACS systems vendor SRSSoft.  (Just for clarity, SRSSoft serves medical practices.)

While Mr. Steele’s comments may not be wildly original, I always like to see discussions of tricky issues like usability boiled down to a few key points, and he’s done a good job here. His arguments, with my commentary:

* Feedback from physicians and other providers should drive EMR usability improvements.

Of course — shouldn’t the software clinicians work every day with to improve health and save lives be adapted to fit the needs of those clinicians? You can’t offer complete freedom when you’re collecting structured data, but clinicians should be able to bend and stretch things as much as possible.

That of course, begs the question of what’s driving usability models right now, doesn’t it?  Certainly, EMR vendors care what clinicians think, but my guess is that the development roadmap has to come first far too often.

Here, let’s pretend I’ve inserted a lengthy rant as to how enterprise software companies in general just don’t connect well with their customers  – something that became painfully obvious to me when I worked for one several years ago. Suffice it to say that I doubt clinicians are as involved in vendors’ UI dev, much less feature set specs, as often as they should be.

* Usability measures should embrace not only primary care, but also specialists.

Again, this seems fairly obvious to me, but seemingly, not to federal officials, who, according to Steele, treated specialty needs as an “afterthought” when creating Meaningful Use standards.

In my opinion, it’s become fairly clear that specialty-facing systems are important, and that regulators should address such systems on their own terms. I’ve seen no sign that they’ve developed plans to do so as of yet, though. (Anyone know more than I do on this?)

* Usability shouldn’t be legislated.

For at least a couple of years, there’s been talk of the FDA’s stepping in and imposing usability rules on EMRs; observers say the rules would be akin to those they already do on medical devices and supporting software. (See more on this issue from medical device connectivity expert Tim Gee here.)

Steele, for his part, thinks such regulations would cause problems. Imposing governmental standards on EHR interface “will inevitably accommodate only a narrow range of users, leaving those with varying preferences and workflows without software to satisfy their usability requirements,” he argues.

I’d like to see Steele get his way on the first two suggestions. If EMR interfaces are driven by clinicians and take specialists into account, it’s far less likely that the government will feel obliged to impose itself upon the marketplace.

But if the industry doesn’t do a better job of partnering with clinicians, expect to see the FDA or other agencies step in.  Regulators may decide that if the industry can’t produce usable EMRs on its own, predictable, rulebound ones will do.

July 3, 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.

Yet Another Top EMR List

As any reader of this blog would know, there may be more EMR rankings out there than there are EMRs themselves. Of course, some lists are taken more seriously than others — KLAS comes to mind — but these days, with the money flowing, virtually everyone who can make a PDF is dipping an oar into the EMR ranking game.

The following list, from a a site called Business-Software.com, is particularly cute in that it would appear to be entirely bought and paid for by vendors — there’s nary a critical analysis to be found in the paper.  (Most of the lists I’ve seen at least pretend to be neutral.)

That being said, I still thought it might stimulate conversation among us to share the list.  I’d love to hear whether you think Business-Software.com has provided any value here, and whether you’ve had particularly good (or bad) experiences with listed EMR sellers.

Here’s Business-Software.com’s list, seemingly in no particular order. Where available there’s a link to get a demo/price quote from the vendors on the list courtesy of Medical Software Advice.

* AdvancedMD: Provides Web-based practice management, medical billing and scheduling software as well as an EMR. Includes a patient portal, e-prescribing and mobile access option.

*  Allscripts: Offers EHRs, practice management, revenue cycle management, document management, e-prescribing. Focuses on emergency department and care management systems for hospitals. Get Price of EMR Vendor EMR Vendor Demo

* Greenway: Offers EHR, integrated with practice management system, along with a database integrating clinical, financial and administrative data. Get Price of EMR Vendor EMR Vendor Demo

* Sage: Products include practice management, EHR, document and image management and point-of-care documentation.

* Aprima: Company offers EHR, practice management and revenue cycle management products, all aimed at medical practices. Get Price of EMR Vendor EMR Vendor Demo

* Kareo: Focuses on small medical practices. Key products include Web-based EHR, medical billing and practice management offerings.

* Abraxas Medical Solutions: Sells unified EMR and practice management solution. Product is powered by a single Microsoft-SQL database.

* Celerity Solutions Group: Provides EHR conversion and systems integration solutions to both large and small medical practices.

* NextGen Healthcare: Offers a very wide range of products, including EHRs for physicians, hospitals, health centers and healthcare providers, as well as practice management and financial management systems, HIE and patient portal options. Get Price of EMR Vendor EMR Vendor Demo

* meridianEMR: EMR focused specifically on urology specialists, as well as a product aimed at general surgery.

What bothers me about this list, by the by, is that while it’s almost certainly a series of advertisements, that’s not marked anywhere.

While physicians aren’t dummies by any means, my guess is that some might get sucked in by any list that says “top” in it if they’re feeling desperate enough.  Here’s hoping physicians catch on to the bias here.

June 5, 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.

Doctors, Is Meaningful Use That Important?

According to an estimate I heard recently, if a doctor’s productivity drops as little as 3 percent to 5 percent the first year after installing an EMR, they’ve already lost more than the $40,000 they can make from Meaningful Use incentives.  And while there will be exceptions, I can’t help but think that most practices will fall into that category.

After all, EMRs aren’t just new software. They represent a new way of thinking about workflow and the practice of medicine generally.  While that may ultimately be a good thing, over the short term it’s likely that even tech-friendly doctors will need some time to adjust.

So, why are medical practices worked up over MU compliance? Certainly, it doesn’t hurt to stay on CMS’s good side, and the $40K sounds sweet at the outset. Also, I’m sure some practices genuinely believe that EMRs can improve the quality of care they provide — and see the incentives as an added benefit.

That being said, I’d argue that the hunger for Meaningful Use incentives puts far too much pressure on doctors, pushing them to make EMR buying decisions before they’re prepared.  Choosing a piece of enterprise software is tough enough even in hospitals with veteran IT teams in place; for smaller practices, which may not have even a single tech on staff, it’s even riskier.

If I ruled the world (OK, even HHS), I’d spend more on bringing vendor selection, training and change management support to doctors, and focus less on payoffs. But as things stand, CMS seems largely focused on handing out the cash. All I can do is encourage doctors not to be blinded by short-term gain, and phase in EMRs at their own pace.  For most practices, I’d argue, that will work much better over the long run.

May 20, 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.

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

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?

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.

If Doctors Bought EMRs Like They Buy Cars…

You know, when you think about an EMR purchase, it’s obvious that there’s plenty of technical considerations involved.  But the truth is, when it comes down to it, most doctors will never need to know anything about APIs or coding or middleware before they pick out a system. They just want the EMR to work.

The thing is, they’ve already made a big investment in technology before — maybe lots of times — even though they probably know little or nothing about how the gears really mesh. I’m talking about automobile buying, of course.  I sort of doubt a single doctor has ever sat through a Webinar on the difference between anti-lock and regular brakes, the advantages of added cargo room or the physics of improved gas mileage. But they still buy cars, don’t they?

No, like everyone else, I’m sure your average doctor takes in commercials, makes a few mental notes as to how the promised benefits fit into their world, digests the information a bit and then goes shopping. At that point, they’re briefed on what features the car has, and tell the salesperson whether that works for them.  Ultimately, they buy something that fits their budget, their needs and probably, their self-image too.

Now, an EMR isn’t a fashion statement — while cars most decidedly are — but in other ways, the purchasing process should be similar.

After all, the software they’re choosing should be as utilitarian as an SUV. They should come to the buying process knowing what needs they’re trying to address (in a car, say, the ability to haul big objects, or in an EMR, being able to enter patient notes quickly and clearly). Hopefully, they have a sense of how they’re going to use their EMR on a day-to-day- basis, as they obviously do when they’re car shopping.

And with any luck, they’ll also know what ongoing problems they’re trying to solve, be they managing the flow of laboratory results, making sure they’re reminded to follow up on preventive care, looking at the health of their patient population and so on.

If a practice knows these things, they won’t be blinded by a blizzard of technical terms or worry about whether they’re on version 2.15 of the latest build. They won’t have to spend much time debating over whether a SaaS or client-server solution makes more sense. They’ll just want to get the job done.

Unfortunately, it’s hard to get to that point when a technology comes in looking all scary, complicated and expensive.  But as any one who’s ever bought a new car knows, you can always take the damned thing back.

March 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.

12 Reasons Why EMRs Improve Patient Care

While HIT insiders and pundits take it as a given that installing an EMR benefits everyone, it’s not so obvious to some gun-shy practices.   Even researchers like myself switch gears every time I try to explain what EMR technology can do.

That’s why I was pleased to come across the following blog item. This piece offers a very solid list of twelve reasons why EMRs can improve patient care, including the following (in no particular order of importance):

*  EMRs are less subject to physical damage and data loss than paper records, as the data can be backed up and stored elsewhere.

* EMRs reduce wait times for patients, as there’s no need to wait for a receptionist to pull a chart and get it to the treating clinician.

* Data stored in an EMR can be sent more easily to other clinicians than when using a paper record. (This may not be true if the EMR is balky — in reality, only an HIE can really fulfill this promise — but it should be true.)

* EMRs that integrate e-prescribing reduce the risk that a  patient will get the wrong drug/dose, as poorly-written prescriptions stop being an issue.

The piece also notes that with an EMR in place, practices should have neater workspaces to use (no paper accumulation) and have better access to care documentation during emergencies.

Now, to inject a note of skepticism here, it’s unlikely that most practices will realize all of these benefits quickly.

In particular, I highly doubt that practices will be able to cut back on paper quickly, since if nothing else, they’ll have to do something with the reams of letters and faxes that other providers send to them, and possibly images as well. (It’s no coincidence that the author works for an HIT consulting firm.)

Still, it’s good to see a well-rounded wrap-up of how EMRs might support day-to-day patient care.  It’s easy to assume that everyone understands EMRs’ potential — but I’d argue that many clinicians are just beginning to draw these conclusions.

That being said, would you add any clinical care benefits to our blogger’s list? Would you disagree with any of his conclusions?

March 28, 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.