Physician EMR Adoption

EMR Value Diminished If Patients Can’t Access Care

A new study from the august Commonwealth Fund has just come out, offering a portrait of primary care practices in ten countries. The study had a lot of interesting data to offer, including news of primary care reforms to meet the needs of aging populations and improve chronic disease care.

One of the key data points drawn from the CF study was that two-thirds of U.S. PCPs reported using EMRs in 2012, up from 46 percent in 2009. That’s obviously a big improvement, though the U.S. still lags behind the U.K., New Zealand and Australia in EMR implementations and use of IT generally.

At the same time, it seems that U.S. citizens still face serious financial obstacles in getting primary care. Fifty-nine percent of U.S. physicians surveyed said that their patients often have trouble paying for care. That’s a big contrast with other countries included in the study, including Norway (4 percent), the U.K. (13 percent) and Switzerland (16 percent). These numbers make sense when you consider that the U.S. is the only country surveyed that doesn’t offer universal health coverage.

Putting aside humanitarian reasons to be troubled by money obstacles to PCP access, there are other issues to consider. To me, the most obvious is the selection bias imposed by financial barriers to care.

Consider one of the big goals a medical home hopes to accomplish, managing chronic conditions effectively across the primary care practice’s population. PCPs can make great use of an EMR to work on such goals, from issuing reminders to get preventive care to tracking patient progress across different demographics to test the impact of new interventions.

The thing is, the power that is a well-tuned EMR is not at its best if the interventions are mostly aimed at those who fit a certain socio-economic profile.

Admittedly, few small PCPs need to be worried about selection bias from a scientific standpoint, as they’re seldom gunning for the next journal article presentation, but looking at the country as a whole, we’re missing out on the collective learning we can generate with clinical data analytics. It seems to me that we’re going to have to address this problem directly if we want to leverage EMRs for the greater public good.

Consumers Hungry For Online Health Data Access

We may be at a major tipping point, folks. It seems that consumers are becoming eager to interact with both their doctors and their health data online, after years of fear and disinterest. In fact, it seems that doctors may be lagging behind.

A new survey from Optum Institute, a part of health insurer UnitedHealth’s Optum division, took a look at attitudes across several major stakeholder groups, including 1,000 physicians, 2,870 U.S. adults and 400 U.S. executives.

Optum found that three out of four patients were interested in accessing their health records online through EMRs, and more th an 60 percent wanted to connect with doctors via e-mail or other Internet vehicles.

And that’s not all. According a summary of the study in MedCityNews:

76 percent of patients are willing to go online to view test results

65 percent want appointment reminders via email

62 percent of patients want to communicate online with their primary care physician

Meanwhile, physicians don’t seem to be keeping up. Only 40 percent of physicians said they had the ability to allow patient EMR access or communicate securely via the Internet.

Why such a gap? Apparently, many of the doctors Optum surveyed have only basic EMRs in place which don’t support patient data access or communication. For example, only 46 percent of physicians’ EMRs offer patient-specific information to help them make decisions and manage their health.

It’s hard to tell from a survey like this whether patients merely like the idea of greater connectivity, or are ready to insist that their doctors get on board. So I wouldn’t go out on a limb at this point and suggest that doctors will lose patients if they don’t get their EMRs souped up quickly.

This does suggest, however, that when physicians make patient data access easier and begin to communicate online, they’ll certainly make some new fans.

One ED Doctor’s View on EHR: A “Certified Nightmare”

I’ve written more posts than most about doctors and the EMRs they love to hate. But too often, observers like myself are forced to share stats from research organizations or (potentially suspect) ratings by groups like KLAS that poll doctors. Not only are stats a bit sterile, they gloss over some of the idiosyncratic issues doctors face when they take on an EMR.

This time, I had the pleasure of a heart to heart with an ED physician. I got more out of our brief conversation than I have in months of writing up survey “results” from interested parties.

The physician, a left-coaster who works with a large non-profit chain, spent a bit of his time telling me about his experiences with his EHR, which is installed in hospitals where he works.

His conclusion: his EHR deserves the “Certified Nightmare” nickname it’s won among the medical staff. From what he says, the EHR installation he’s dealing is way too hard to use. To him, the user interface imposes a nasty “click burden” that slows him down needlessly.

Before you leap to the conclusion that he’s a Luddite, know that our friendly ED doc is completely paperless at home and that this EHR isn’t his first EHR. He’s actually pretty fluent with technical stuff.

So I have to believe him when he says that the EMRs he’s looked at are clumsy as heck. “The height of EMR design seems to be Microsoft Outlook 2003,” he says. I wish he was wrong!

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.

The Top Three Things The Mass Media Does To Delay EMR Adoption

Now that the government is pushing EMR use, the mainstream press has begun to report on the issue.

True, some astute editors are beginning to dig in to the problems that matter, such as securing patient data and challenges to getting physicians on board.

But most consumer publications, with their penchant for simplifying and condensing issues, are muddying the waters even further. Here’s some things they’re doing which, I’d argue, are actually slowing down the EMR adoption process:

* Asking consumers whether they “want” an EMR: Let’s be honest: most consumers have only a vague idea of what an EMR is. You might as well ask them whether they’d like oh, I don’t know, a confoobatron. If they think those confoobatrons are supposed to be the latest thing in medicine, they’ll say sure, I’d want one of those! In other words, you’re not giving doctors and hospitals real feedback as to how EMRs will foster relationships with their patients. It’s easy for clinicians to write off such responses as bogus and avoid adoption for a while longer.

* Focusing on a few spectacular security breaches: Yes, it’s really unfortunate that hospital staffers stole a peek at some Hollywood celeb’s medical data, or that a stolen laptop stocked with unencrypted data exposed patients at Hospital A to medical ID theft. But in playing up spectacular security breaches, mass media players distract everyone from the real issues. As we all know, most hospitals and doctors have far less glamorous problems to worry about, such as encrypting data, controlling access by role and seeing to it that staff are trained in security policies. But playing up a few disasters — such as stolen laptops or celebrity medical record leaks — makes it sound like security is beyond the reach of your average provider.

* Doing little to examine why physician adoption of EMRs is still low: While you will see the likes of USA Today look at abysmal EMR adoption rates, these stories usually collect a few random interviews with association heads or a random private practitioner and cite a few of their random headaches. These stories don’t dig into the really important issues (such as fear of productivity loss, lack of clinician buy in and techno-phobia) that are stopping the train. While doctors obviously read trade publications like this one, they’re human, and if the USA Today story they skimmed on the train doesn’t address their concerns, it’s easy to stay tuned out on EMRs for a while longer.

OK, maybe I’m being a bit unfair here. Having been an editor for decades, I know the mass media can’t take the place of blogs like this that focus on serious professional issues. But I still wish that my colleagues in the consumer press would give EMR issues as much serious thought as, say, professional football. Wouldn’t that be refreshing?

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EMR Value Diminished If Patients Can’t Access Care

Consumers Hungry For Online Health Data Access

One ED Doctor’s View on EHR: A “Certified Nightmare”

When Physicians Own Practice, EMR Implementation Feels Tougher

The Top Three Things The Mass Media Does To Delay EMR Adoption

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