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One of my readers sent me an interesting comment about Physician interest in the EMR stimulus:

Personally, I was under the impression that most physicians really didn’t take the time to read such things [like this post about harmful consequences of the Government's EHR stimulus]…that they’d rather be thumbing through Golfer’s Digest or Conde Nast’s Traveler. It’s become quite clear that, when something comes along such as a government program like this that can affect their bottom-line, ears perk up and attention is paid. Now, if only more would speak up and voice their opinions to HHS…

I’ve started to see a bit of a turn myself on this site and EMR and HIPAA by physicians who aren’t too happy with the EMR stimulus. They’re starting to voice their concerns more and more. Some of them are a bit uninformed. For example, they want a “cost effective product that works” and then they ask why the VA system can’t be expanded for civilian use. I’ve talked a lot before about why the VA system has challenges, especially in ambulatory EMR. However, by starting the conversation about EMR, they’ll learn things like this.

I have a feeling that the lasting legacy of the EMR stimulus will be the increased awareness and interest in EMR. Maybe the government should never spend the $18 billion of EMR stimulus money since they’ve already gotten the desired effect of increasing interest in EMR. If after this much increased interest doctors still don’t want to implement an EMR, then maybe we shouldn’t pay them [force them] to do it.

SRSsoft, an EMR vendor, put out an interesting press release putting the lost democratic senate seat in Massachusetts with healthcare reform and EHR adoption. Here’s a quote from the press release:

“The question is not whether we need healthcare reform,” says Evan Steele, CEO, SRSsoft. “Rather, the voters voiced their concern that reform must benefit consumers and physicians, not just government, insurance companies, and vendors. This election must open the government to input from all stakeholders, and that is a good sign for the constituents of SRS—the physicians—who feel that their voice is not being heard on healthcare reform and on EHR adoption.”

Honestly, I don’t see the change in the Senate seat affecting EMR adoption at all. However, I think it will have a big impact on healthcare reform. I’ve said before that the healthcare reform has opened our eyes to the government processes in ways we’d never seen before. I think that the HITECH act has done much of the same for those of us interested in EMR legislation and rule making.

I was really intrigued by this letter sent from SRSsoft CEO, Evan Steele, to the CTO of the Obama Administration about the current administration’s EHR direction. Here’s a small excerpt from the letter posted on Health Data Management:

“I am writing to you directly, rather than posting on the FACA blog, because I am deeply concerned that the path the government is taking will inevitably lead to failure. You asked physicians for input and they answered loudly and clearly–traditional EHR technology does not work for them. Their comments are difficult to ignore.

“The government is endorsing the exact technology that has a 50% failure rate. As stated in the blog comments, physicians simply find these EHRs unusable. Of the 60 blog comments on real-world implementation experiences, 57 reported EHR failures and shortcomings–writers documented painful and costly EHR de-installations, or explained the reasons why they would not even try to implement “traditional” EHRs. There is no reason to expect outcomes to be different in the future–vendors have made no significant changes to these products to mitigate the formidable obstacles preventing their adoption. The problems cited are daunting:

* “Physicians will not purchase productivity-decreasing software–particularly now, as they face increasing demand and diminishing reimbursements. They reported productivity losses as high as 40%, and the impact did not diminish over time.

The sad part is that Evan’s letter is likely to fall on deaf ears. First, because Aneesh Chopra probably doesn’t care much about EMR software. Second, a letter from an EMR vendor who wants the rules changed to get better access to the $36.3 billion in EMR stimulus money for his customers is likely to be seen as a political move. Even if Evan is correct with what he’s saying, that doesn’t mean that Aneesh will realize it. Third, is it too late? The HITECH legislation is past. Can HHS really make that much of a difference at this point? Sadly, I don’t think Evan we’ll feel any better 2 years from now when he says, “I told you so.”

This is a part of a post on the SRSsoft website. I am a fan of SRSsoft because I think they have it right when they focus on “provider productivity” as a key component of any “good” EMR. See the link below to see the whole blog post, but basically, they went to Washington to advocate for EMRs which improve productivity and enhance the physician-patient relationship.

This is an excerpt from the post:

The signers of this petition are not all SRS clients. Other providers reached out to us and asked that we stand up for them as well. SRS users or not, they are passionate about EHRs, and they speak from positive and negative experience with a variety of EHR products. Three fundamental themes dominated:

*Physicians will not adopt technology that compromises their productivity,
*They will not become data entry clerks, and
*They will not jeopardize the physician-patient relationship.
*No financial incentives or penalties will persuade these physicians to take actions they deem detrimental, or not valuable, to their practices.

Bottom line is that most physicians (if they are smart) will not be induced by incentive or penalties to take on an EMR unless the EMR makes them more productive! I agree with this. Washington needs to make the definition of “meaningful use” and “certified” flexible enough to encompass EMRs that are innovative and enhance our ability to be great doctors and provide excellent care.

SRSsoft EMR emphasizes speed, efficiency and provider productivity. If your EMR slows you down and makes you less productive, you will lose money and there will be no ROI. More importantly your income will diminish because you will be seeing fewer patients per hour! The $44,000 to $64,000 offered in government incentives (over 5 years) will be insignificant compared to the income you lose due to decreased productivity.

What are your thoughts about provider productivity? For complete post from SRSsoft’s CEO go to: http://blog.srssoft.com/?p=496

This is a SHOUT OUT to all doctors who use EMRs. Which EMRs do you use and how do you like them. Do you love them or hate them? Are you luke warm in your like or dislike? Tell us which EMR you have and how you feel about it. Also tell us what you would do (the mistakes and the good moves) if you were looking into getting an EMR at this time.

I have personally looked at Greenway PrimeSuite, SOAPware, SRSsoft, e-MDs, AmazingCharts, NextGen, Centricity and others.

Can you comment on the cost and the usability?. Let’s share information so we can help other doctors choose systems that are usable, simple to learn, effective and efficient.

If you don’t have an EMR and are looking into one, what questions would you have for those “who have gone before you”? What advice would you be interested in receiving?

One Hundred Percent of Doctors and their offices use Practice Management Systems (PMS). Only 3% user “fully functional” EMR Systems. Why only 3% with EMRs and 100% with PM Systems?

The government is going to pay us $44,000 per doctor to use an EMR. They are going to give us a 2% Medicare bonus and other pay-for-performance incentives and they are going to penalize us in the future if we don’t use EMRs. In addition, hospitals are allowed to pay 85% of the cost of the software and training. Will all this money get us the use EMR? Can we be bought? Is it in our interest to use EMRs?

The CEO of SRSsoft tells us that this type of money is not significant if the EMR makes you less productive and less efficient. For example, if you bill $500,000 per year and your EMR makes you 10% less efficient, you lose $50,000 per year!

I agree with this CEO. We (doctors) will not embrace EMR systems until they are usable and they add value! “Usability is the effectiveness, efficiency, and satisfaction with which the intended users can achieve their tasks in the intended context of product use.” This definition comes from NIST, ISO and UserCentricity. Adding value means that it makes our jobs more enjoyable, shortens our work day or helps us provide better care.

Doctors use practice management systems because they are usable and they add value. Doctors do not use EMR Systems because most DO NOT add value and they are not usable. There are so many bad EMR systems on the market that the stench and confusion has caused many doctors to not even look (they ask their colleagues who have EMRs and these colleagues say “stay away, it is not worth the cost, aggravation and problems”).

I believe that there are some very good EMRs on the market. The challenge is to find them and promote them. If we (doctors) can find the good EMRs, word will spread and implementation will happen very rapidly!