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Pediatricians Find EMRs Lacking

Posted on December 10, 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.

While there’s no lack of specialty EMRs out there, it seems that pediatricians feel undeserved anyway. In fact, a new study suggests that there are five functions pediatricians look for in EMRs which are seldom found in a single system.

Almost half of pediatricians have adopted EMRs (48.5 percent), and 61.7 percent of doctors in internal medicine/pediatrics, according to a report in American Medical News.  (The data was drawn from marketing research firm SK&A, which does ongoing surveys on EMR adoption and use at 250,000-odd practices nationwide.)

The study, which appears in this month’s issue of the journal  Pediatrics, reports on a random survey of 646 postresidency pediatricians done in 2009 before the MU incentive program began. At the time, only 3 percent were using an EMR that they considered fully-functional and supportive of their specialty.

The authors say that pediatricians need five key features in place to consider an EMR complete. These include tracking of well-child visits, support of growth chart analysis, immunization tracking, immunization forecasting and weight-based drug dosing. Unfortunately, Meaningful Use standards  are nowhere near addressing the entire bundle of functions, they note.

So, are there any solutions for pediatricians which have emerged since the study survey was done? Certainly, there are scads of EMRs out there being marketed as pediatric EMRs. However, at first glance at least, most of the market for pediatric EMR solutions seems to be general  purpose systems offering pediatrics-specific templates.

On the horizon, however, there may be a glimmer of hope. Apparently, the Agency for Healthcare Quality and Research has designed a model children’s EMR which includes a list of child-specific functions, and ONC anticipates including these features in future stages of the EMR certification criteria.

In the mean time, it looks like pediatricians face the need to either work with (arguably) inefficient systems or customize systems on their own. Neither possibility would sound good if you were a pediatrician, would it?

An Interview with Dr. Nan Nuessle (@DrNanN) – #HITsm Spotlight

Posted on October 31, 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.

For the past few months we’ve been doing a summary of the #HITsm chats that happen each Friday. I once heard Michael Gaspar, who does social media at HIMSS, describe Twitter hashtags as a community of users. I think this is definitely true when it comes to the #HITsm hashtag. With that in mind, I thought it would be interesting to learn more about the members of the #HITsm community and to learn from the members of the #HITsm community.

The first in this series of #HITsm spotlights is with @DrNanN (Nanette Nuessle, MD). She gives some amazing insights. Enjoy!

When did you get involved in social media? What got you started with it?
I got started in social media 2 years ago. I was at a national meeting of pediatricians. One of my colleagues said I needed to be on Twitter. I told her I didn’t know anything about it. She grabbed my phone, asked how the kids in my practice address me, then handed the phone back and said, “you’re on twitter.” I didn’t do anything but follow for 2-3 months. I didn’t really try to build a following until about 18 months ago. Now, I have nearly 4,000 followers.

What benefits have you received from social media?
Social media has given me a way to talk with patients outside the 10-20 minute office visit. I can post information that is specific to my practice, or tell them of late-breaking news. It gives me a vehicle for discussing that late-breaking news with other professionals. My attention to these 2 things has greatly improved my ongoing education. Finally, it has opened career paths that allow me to help other physicians who are transitioning to the use of electronic health records and social media.

Looking at the world of healthcare IT, what do you see as the most important things happening today?
The single most important thing in healthcare today is the budding widespread use of electronic health records. We must remember that this practice is in it’s infancy. It is still the most powerful tool to reach physicians since the development of the stethoscope.

As a doctor, what’s your view of the current EHR world?
The EHR world is in it’s infancy. I have been sending prescriptions electronically since 2005, and using electronic health records for even longer. Many providers are just starting into this world. The potential to change the face of medicine is obvious. We can get the record of a walk-in patient before the front desk finishes registering them for their visit. We have access to all visits and all studies done in-house at all times. However, there are still kinks being worked out that will improve efficiency for providers. This includes day-to-day ease of using an ehr, as well as sharing between different clinical entities (interoperability).

What is the most promising technology for pediatricians?
We live in a mobile society. Most adults don’t live in the same neighborhood or town where they grew up. Most children don’t stay with the same pediatrician from birth to their 18th birthday. For the pediatrician, the HIE is going to be crucial. This will allow us to track immunizations and routine labs for all children as they move through their childhood.

If you could wake up tomorrow and have one part of healthcare solved, what would it be?
I have 2 wishes, Magic Genie. One is to solve interoperability. The other is to see prenatal care and immunizations made free for all people living in the US. The first will revolutionize healthcare in the US, the second will revolutionize health itself.

What health IT issue do you see out there that not enough people are talking about?
Efficiency. Everyone is talking about Meaningful Use and Interoperability. These are certainly important issues. However, without efficiency, providers are going to continue to fight the use of ehrs. Before using an EHR, I routinely saw 30-32 patients a day. Now, I am exhausted at 20-25, depending upon the EHR. My staff complain that it takes over 10 minutes to “room” a new patient because of all the data entry involved. Rooming a new patient used to take 2-4 minutes. Consequently, we are working harder but seeing fewer patients. This translates to less money. Unless we address the issue of efficiency, EHRs will never reach their full potential.

Where or to whom do you look in order to stay up with all that’s happening in healthcare IT? What’s part of your daily routine?
I keep up with healthcare IT in 2 ways. One is by reading daily electronic newsletters, particularly HealthCareITNewsDay.The other is by networking with others in the field.

Any final thoughts?
Electronic health records are in their infancy. For them to grow, we need to nurture providers into this field. There has to be more dialogue between physicians, nurses and IT professionals. We speak different languages. We need to sit down at the table together and share our thoughts without letting our personalities get in the way. I think if this is done the potential in the field of healthcare IT is limitless.

Are EMRs the Answer to Small-Practice Challenges?

Posted on March 21, 2012 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

During my recent visit to my daughter’s pediatrician, I was pleasantly surprised to see a computer up and humming along in a corner of the exam room. The last time we had been in, some six months before, that same piece of equipment sat shrink-wrapped (as it had been for a few months even before that), waiting for an eager clinician to tear open its plastic casing and put its digital capabilities to good use.

I had been dreading this particular appointment – our first with the one pediatrician left at the practice. Our usual doctor had left a few month earlier for parts unknown, so I wasn’t sure who – or what – to expect. The advice nurse who made my last minute “work-in” appointment was kind enough to make sure I understood that due to the second doctor’s departure, we would likely wait an extremely long time.

Our wait, which ended up being no longer than usual, gave me time to do a bit of snooping around the new computer. No keys or mouse were touched, but I did notice that NextGen was the practice’s EMR of choice. Yes, the nurse did have her back turned to us as she asked me questions about the reason for our visit and entered responses into the EMR. When I asked her if she liked the new system, she gave a rather noncommittal response in close approximation to “some days I do, some days I don’t.”

I’m guessing she may have bigger issues to deal with, such as assisting the patients of a double-, sometimes triple-booked pediatrician. The single-doc situation made me wonder how much training the practice’s staff had time for before and during go-live. I could certainly believe that follow-up training will take a backseat until a second pediatrician is brought into the fold and everyone gets back to a somewhat normal workload.

So how do small practices in similar situations do it? How do they find time for EMR training when overscheduled? Do vendors often step in and help with extra resources? How long do practices go before hiring additional staff? (That’s an off-topic question, I know, but one I’d still like an answer to.) I’d like to think that in the long run, the new EMR would of course help make everyone more efficient, and us patient parents more satisfied. Let me know what you find out in the comments below.

Pediatrics Face Unique Set of EMR Challenges

Posted on October 26, 2011 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

My recent blog about Sandhills Pediatrics and its successful implementation of an EMR prompted, fortunately, a very intriguing comment from Chip Hart, a Director of Sales and Marketing at Physicians’ Computer Company who also maintains the blog “Confessions of a Pediatric Practice Consultant: True Stories from the land of Pediatric Practice Management.” He wrote: “I’ll spare everyone the diatribe about how ARRA deals with pediatricians and how only about 1/2 of them qualify, as I write to make one quick statement.” There’s a story there, I thought to myself. So, being an avid observer of pediatric EMR news and views, I reached out to him to gauge his thoughts on where healthcare IT solutions fit in the world of pediatricians.

What sort of challenges are you seeing pediatric practices facing when it comes to implementing EMR systems?
“On one hand, most of the challenges they face are hardly unique to pediatrics: resistance to change, practice differences, the lack of time and resources to be trained and configured properly, poor support, etc.

“Specific to pediatrics, there are two major issues.  First, children are not simply small adults and EMRs, as a rule, are written for adult medicine. There are many pediatric-specific features and functionality that a pediatric practice needs that simply aren’t met by your large, generic system. Simply claiming “pediatric templates” isn’t enough.

“Second, although every specialty complains about the hit that EMRs take on their productivity, pediatricians are obviously in the worst shape. Their volume is the highest and their payment is the lowest. Just adding a minute to each encounter means an extra 30 minutes of charting a day … and I hear stories, daily, of practices adding another 1 to 2 hours! Pediatricians can’t afford to see 5-percent fewer patients. Radiologists can. And pediatricians really like to eat dinner with their families.

“One second-tier issue is that less than 50 percent of all pediatric practices don’t qualify for ARRA and the regional extension centers (RECs), as a rule, don’t understand the Medicaid rules well.  Thus, we have clients and potential clients calling us to ask how they can get money they’ll never get, or to tell us some crazy thing a REC person told them.”

Are there different sets of challenges for those that are private practices versus those that are hospital/healthcare system affiliated?
“Unquestionably – the big one being that hospital/health system pediatricians simply won’t have a choice or even a voice in the process. Yes, I’ve worked with some who appear to be at the table, but in the end … you get what they hand you. Right now, Epic is pushing everyone out but that pendulum will swing back.

Also, those employed physicians don’t have to consider the impact on their productivity in the same way. I’ve met too many peds offices whose docs didn’t take home checks for a few months after implementation – that’s not right.”

Why do you think practices like Sandhills “get it” in terms of moving forward with HIT implementations, and just being forward thinkers in general?
“If I could answer that question, I’d only be working with those practices! Every successful practice I know is successful in a different way for different reasons, but there is one common trait I see in many of them: They run their practices like the businesses they are. Keep the docs in the exam rooms, where they can generate revenue, and hire professionals to actually run the business. Just because it says “MD” after your name doesn’t mean you’re the best-qualified person to run your office. Would Dirk Nowitski or Lebron James make good coaches? I doubt it.

“In the case of Sandhills, they have some excellent, excellent staff who bring some non-healthcare experience to the table. Although I’ve seen it fail, having some management that comes from outside the healthcare system to ask and answer some tough questions pays off for a lot of practices.

“We’ve enjoyed working with them.  I should also add that they, like the other ‘heads up’ clients I know, realize that we’re on the same team. That helps tremendously.”

How long have you offered the PCC EMR? What sort of up tick in implementations have you seen since ARRA/HITECH came about?
“Our PM has had pediatric clinical features (immunization tracking, registry interfaces, well visit recall, etc.) for almost 30 years, but the official EMR itself was released about 2 years ago.

“When ARRA was first announced, we received a lot of calls, all along the lines of, “Where do I get my free money?”  It was very frustrating to explain that it would be state dependent (about a quarter of them still can’t get it) and half of our clients will never qualify due to the Medicaid requirements.

“Things are starting to settle down and get organized.  Still, we are busier right now than we have ever been. We are telling potential clients they might get installed in May or June. A nice problem to have, but it’s not fun to get some excited only to explain it will be 6 months, especially when it used to be 6 weeks!”

Are any of your pediatric clients thinking of becoming involved in ACOs?
“Thinking?  Yes.  They’re all being told how if they don’t get big, they’ll be out of business, which is utter BS. The rules, as we know them now, seem to make no sense whatsoever for pediatricians. I did see a compelling presentation by Colleen Kraft at the AAP NCE last week that very much supported the ACO-esque model she employs, but I think her situation is both unique and not potentially an ACO.

“With some issues – 5010, PCMH, etc. – we take a pro-active stance. With ACOs, I’m glad to let someone else jump first.”

How will your solutions enable your customers to integrate with ACOs or coordinated care programs?
“Far too soon to tell.  In general, I can say, “Hey, we have had really good reports that have tracked patient populations for years.”  Our clients use them all the time, as it’s both good medicine and good business.  As a practical tool, I’d put our patient recall program up against anyone’s – your front desk can crank out a list of kids who need flu shots or asthma followups in seconds – but we don’t know quite what the ACOs will need.

“One thing we’ve learned, though: when a small peds office puts its data in the hands of a large entity, it’s worth double-checking the results. For more than 20 years, I’ve helped our clients fight insurance companies (which an ACO emulates) and the insurance companies never have the data right. Ever. So if a private peds office can work with us and still be in an ACO, they’ll be able to confirm the accounting.

“Here’s my prediction: As ACOs grow, the practices who participate are going to regret losing control of their data. I’m really going out on a limb there, I know.

What do you think is the greatest challenge being faced by pediatrics when it comes to keeping up with healthcare IT?
“Not getting run over by the Juggernaut.  Everyone else’s demands are put ahead of the pediatricians and the peds usually get served what everyone else is eating.  And it rarely suits them.

“I also tell them all the time: ignore the Meaningful Use money. Completely. And ignore the “deal” that you can get from your local hospital/IPA/etc. Pick the EHR that suits you the most and go with that. All the discounts or federal checks in the world won’t make up for even a 5-percent hit in your productivity or having to spend an extra 10-20 hours a month on charting or IT work. If you do like the local deal, great!  But don’t feel like you have to leap in.”

So there you have it folks. I’d be interested to hear from a pediatrician or two who has gone through or is going through some sort of HIT implementation as a follow-up to these views. Feel free to get in touch with me via the comments section below.