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Practice’s EMR Implementation Drove Up Costs For Six Months

Posted on September 28, 2018 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.

Everyone knows that providers incur EMR-related costs until well after it is implemented. According to a new study, in fact, one medical incurred higher costs for six months after its implementation.

The study, which appeared recently in The Journal of Bone & Joint Surgery, calculated the impact of an EMR implementation on labor costs and productivity at an outpatient orthopedic clinic. The researchers conducting the study used time-driven activity-based costing to estimate EMR-related expenses.

To conduct the study, the research team timed 143 patients prospectively throughout their clinic visit, both before implementation of the hospital system-wide EMR and then again at two months, six months and two years after the implementation.

The researchers found that after the first two months, total labor costs per patient had shot up from $36.88 to $46.04.

One reason for the higher costs was a growth in the amount of time attending surgeons spent per patient, which went up from 9.38 to 10.97 minutes, increasing surgeon cost from $21 to $27.01. In addition, certified medical assistants for spending what time assessing patients, with the time spent almost tripling from 3.42 to 9.1 minutes.

On top of all of this, providers were spending more than twice as much time documenting patient encounters as they had before, up to 7.6 minutes from 3.3 minutes prior to the implementation.

By the six-month mark, however, labor costs per patient had largely returned to their previous levels, settling at $38.75 compared with $36.88 prior to the installation, and expense which remain at the same level when calculated at two years after the EMR implementation.

However, providers were spending even more time documenting encounters than they had before the rolling, with time climbing to 8.43 minutes or roughly 5 minutes more than prior to the introduction of the EMR. Not only that, providers were spending less time interacting with patients, falling to 10.03 as compared with 14.65 minutes in the past.

Sadly, we might have been able to predict this outcome. Clearly, the clinic’s EMR implementation has burdened its providers and further minimized time the providers spend with their patients. This, unfortunately, is more of a rule than an exception.

So why did the ortho practice even bother? It’s hard to say. The study doesn’t say what the practice hoped to accomplish by putting the EMR in place, or whether it met those goals. Given that the system was still in place after two years one would hope that it was providing some form of value.

Truthfully, I’d much rather have learned about what the clinic actually got for its investment than how long it took to get everyone trained up and using it. To be fair, though, this data might have some relevance to the hospital systems that manage a broad spectrum of medical practices, and that’s worth something.

Patient Satisfaction Drops After Ambulatory EHR Is Rolled Out

Posted on June 4, 2018 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.

In theory, EHR implementations are supposed to not only make providers’ jobs easier but ultimately, improve patient satisfaction too. The idea is that EHRs will eventually add something beneficial to physician routines and ultimately improving care processes. Of course, there’s a lot of question as to whether EHRs can now or will ever do so, but researchers continue to look at different use cases.

For example, new research published in JAMIA has concluded that while they weren’t too thrilled by the ambulatory EHR they were using, a group of OB/GYN practices showed some enthusiasm once the outpatient EHR was attached to the one collecting data on their related inpatient perinatal unit.

The purpose of the study was to look at how the installation of the ambulatory EHR within the OB/GYN practices and subsequent connection to an inpatient perinatal EHR affected providers’ attitudes toward sharing of clinical information. It also looked at the impact all of this had on patient satisfaction.

To conduct the study, researchers collected data on both provider and patient satisfaction. They assessed provider satisfaction by conducting four surveys staged across the phased implementation of the EHR. To measure patient satisfaction, meanwhile, they drew on data from Press Ganey surveys managed by the healthcare network using the usual process.

Their ultimate goal was to determine how provider and patient perceptions changed as the EHR system enabled greater information flow between the OB/GYN practices in the hospital.

What the study found was that the outpatient OB/GYN providers were less satisfied with how the EHR affected their work processes than other clinical and non-clinical staff. On the other hand, they grew more satisfied with their access to information once the inpatient perinatal triage unit offered useful functions. Specifically, they were happier with their access to information from the inpatient system once its capabilities included the ability to send automatic data flows from triage back to the OB/GYN offices.

On the other hand, overall patient reactions to the project appeared to be negative. Patient satisfaction fell after the installation of the ambulatory EHR, and researchers could find no evidence that patient satisfaction rebounded after the information sharing process began between inpatient and outpatient settings.

In summary, the study concluded, if providers are dissatisfied with their EHR system, and those difficulties undercut patient care, the process could negatively impact patient satisfaction. The authors recommended that healthcare organizations take extra care to maintain good communication with patients during this process.

EHR Usability Problems Linked To Potential Patient Harm

Posted on April 9, 2018 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.

If you’re a clinician, you’ve probably always felt that EHR usability problems were a factor in some patient care glitches. Now, there’s some research backing up this hunch. While the numbers of EHR-specific events represented in the study are relatively low, its lead researcher said that it probably underestimated the problem by several orders of magnitude.

The study, which was profiled in the American Journal of Managed Care concluded, that at least some patient safety events were attributable to usability issues. The study, which was just published in JAMA, involved the analysis of nearly 2 million reported safety events taking place from 2013 to 2016 in 571 healthcare facilities in Pennsylvania. The data also included records from a large mid-Atlantic multi-hospital academic medical system.

Of the 1.735 million reports, 1,956 (0.11%) directly mentioned an EHR vendor or product. Also, 557 (0.03%) include language explicitly suggesting that usability concerns played a role in possible patient harm, AJMC reported.

Meanwhile, of the 557 events, 84% involved a situation where patients needed to be monitored to preclude harm, 14% of events potentially caused temporary harm, 1% potentially caused permanent harm and under 1% (2 cases), resulted in death.

The lead researcher on the study, Raj Ratwani, PhD, MA, told the AJMC that these issues are unlikely to resolve unless EHR vendors better understand how providers manage the rollout of their products.

Even if the vendor has done a good job with usability, he suggests, healthcare organizations adopting the platform sometimes make changes to the final configuration during their implementation of the product, something which could be undoing some of the smart usability choices and safety choices made by the vendor. “We really need to focus on the variability that’s occurring during the implementation and ensuring that vendors and providers are working together,” Ratwani said.

Along the way, it’s worth pointing out that the researchers themselves feel that the actual number of usability-related patient safety events could be far higher than the study would suggest.

Ratwani cautioned that he and his team took a “very, very conservative approach” to how they analyzed the patient safety reports. In fact, he suspects that since patient safety events are substantially underreported, the number of events related to poor usability is probably also very understated as well.

He also noted that while the study only included reports that explicitly mentioned the name of the vendor or product, clinicians usually don’t include such names when their writing up a safety report.

Preventable Issues Arise When Paper Documentation is Used

Posted on November 5, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

It’s an unfortunate truth that the health care system is not fool proof, and mistakes happen. Many of these mistakes happen because of paperwork that is lost, unreadable, or misplaced. Even with the implementation of EMRs across the country, many healthcare providers are still relying on paper for many aspects of their practice. Referral MD created an infographic that shows some of the current problems in healthcare related to using paper documents:

Pretty scary, if you ask me. Doctor’s are notorious for having terrible handwriting, but 7000 patients die a year because of it? And 30 percent of tests have to be reordered because the orders were misplaced? These statistics are startling, in large part because they are preventable. Those are only two of the facts presented in this infographic, and in combination with everything else, it makes me wonder why anyone that has an EMR would still use paper, and why the practices that don’t use EMRs haven’t started. It makes me not want to trust the system even more.

I can see how patients and doctors alike may find it hard to switch over. When I wasn’t given a physical, paper prescription to take to the pharmacy to get my son’s medication, I was a bit taken back, but it made things so much easier when I actually arrived at the pharmacy. I compare that to the many prescriptions and lab orders I lost during my pregnancy because I set it down and forgot to pick it up again, never to find it again until months later while doing some cleaning. It made me really wish my OB/GYN had electronic documents more incorporated into his practice. I’m curious to see if he has any EMR at all. Since he’s been a doctor for 40+ years, maybe he’s having a hard time making the switch.

It’s one thing if a person dies from a terminal illness, but to pass away because of a preventable mistake is uncalled for. I realize that no one is perfect. Everyone makes mistakes. But when a mistake could mean someone dying, a patient’s information being misused, or a HIPAA violation occurring, something is wrong. Hopefully as EMRs become better and more practices have them, paper documentation will become a thing of the past, and these mistakes, breeches, and all other issues that are related to using paper, will go that way as well.

REC Numbers for REACH (Minnesota and North Dakota Doctors)

Posted on June 7, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

For those not familiar with the RECs (Regional Extension Centers), REACH, a nonprofit federal Health Information Technology Regional Extension Center, helps providers and clinics throughout Minnesota and North Dakota to either optimize current EHR or implement EHR into their practice. They aim to help different providers and clinics to reach stage 1 meaningful use in a year or less. REACH offers many services in their program to reach this goal, such as readiness and meaningful use assessments, contract review and coaching, organization and workflow redesign, and basic report writing.

REACH recently put out some numbers about their EHR reach that were quite interesting. Currently more than 4,700 providers and 513 clinics are benefiting from the services offered by REACH. They have reached above their goal by helping 3,600 priority primary care providers (this goal was exceeded by 1,149). Below are some recent REACH numbers:

  • 4,749 priority primary care providers
  •  3,541 e-prescribing and quality reporting
  • 301 having achieved meaningful use
  • 104 critical access/rural hospitals (84% of eligible hospitals
  • 33 e-prescribing and quality reporting
  • 11 having achieved meaningful use

Below is a really interesting map that shows the locations of clinics and hospitals currently served by REACH.

I appreciate RECs like REACH that are putting out the data for how many doctors they’ve helped. What do people think of the RECs now?

EHR Budgeting Webinar Slides

Posted on April 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.

The HIT Community recently did a webinar on EHR budgeting that I found quite interesting. Looking at the slides (embedded below), you can see that it covers a number of the important factors related to budgeting for an EHR. They talk about various cost savings and expenses you’ll have. I love that this goes beyond the EHR incentive money.

I’ve covered a lot of these various items before and I have them listed on my EHR & EMR benefits page. I also go into detail on most of them in my EHR selection e-book.

Now for their presentation slides:

You can find a link to the Live recording of the webinar on the HIT Community website.

Life After EMR Implementation

Posted on November 7, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

I spent a lifetime as an IT developer before I landed my present gig as technical writer in a health IT company. I can tell you from experience, that for many development teams, the implementation date is the biggie that the developers are racing against. And yet, the real fun often starts post-implementation. It’s not that different even with EMR implementation, you’ll be happy to know, at least according to this article at CMIO.net

According to the story, here’s what happened at Hospital Sisters Health System in Wisconsin and Illinois: A couple of months after their CPOE (Computerized Physician Order Entry) and EHR went live, the CIO received a letter with listing 38 issues faced by physicians using the EMR, with an ultimatum that these problems be fixed within two weeks. Half were known issues, and another quarter were training related. But even so, “The installation team was taken aback by the letter, including the physician champion.”

Now, not every IT project is like the one described but here are some lessons worth repeating from the Hospital Sisters example:

  • Prepare, prepare, prepare: That there will be unexpected issues is a given. The problem is not that issues crop up. How prepared you are – knowing how, when, who will handle glitches – is the difference between success and failure.
  • Train Your Users: I honestly get turned off when someone utters “It’s self-explanatory, really,” when it’s related to a software product. Yes, it might be, to you, tech geek, but not everyone was born with the chip embedded in their being. Expect to spend some time training your end users. Well-structured training sessions not only impart the know-how but can also be crucial rapport-building occasions with your buyers.
  • Support Your Users: After the initial euphoria of product launch, using your product might actually bring down the productivity some as users get used to using your product on a regular basis.

About Half of EHR Incentive Money Goes to Existing EHR Users

Posted on October 12, 2011 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.

iWatch News recently put out an article talking about a survey that suggests that about half of the EHR incentive money is going to EHR users that have been using an EHR since well before the HITECH act.

Here’s an excerpt describing the process they used to get the 50% existing EHR user number:

iWatch News attempted through phone and email to interview all providers who had received the money; 62, or about a third, of the 188 distinct practices (some with multiple doctors who received money) and hospital chains on the list chose to respond. Health providers were asked for the brand of the technology they installed, when they installed it, whether they would recommend it to other providers and whether they have had any problems with it.

Of those who responded to the questions, almost half of the providers had installed the technology in the years before the stimulus program was announced — some dating as far back as the 1990s.

This doesn’t sound like the most statistically significant survey that there could be. Plus, I’d be interested to know what date they used for when someone “implemented” their EMR and when the HITECH Act actually had any influence on their EHR decision making process. The point being that I’m guessing that a large number of those surveyed were counted as being in the 50% that were influenced by the HITECH Act when in fact many of them probably barely knew about the HITECH Act and had started their EHR implementation or would have started their EHR implementation with or without their HITECH Act.

While the article spins this as the government incentive not increasing EHR adoption, I’d say that 50% is a pretty good number. I’d have thought that the number of existing EHR users that got the EHR incentive money would be a lot higher. Maybe it actually is based on what I said in the last paragraph.

As far as the EHR stimulus money going to already implemented EHR installs, it’s not as bad as what some may say. Sure, if the goal of the HITECH Act was just to get widespread EHR adoption, then it would be considered a failure on that count. However, there are some benefits that go beyond new EHR adoption. For example, many of the existing EHR users were no doubt using old EHR software that could have been upgraded, but never was upgraded. Meaningful use and the EHR incentive money has required them to do the upgrades and will require that they stay up to date as the new MU stages come out. Using the latest software release is good on many levels.

Another advantage of meaningful use and EHR incentives for long time EHR users is it gets them to actually use the software. I know it’s a unique concept, but unless you’re in the industry you probably don’t realize that many many many EHR implementations only use about 10% of the features that are available. We could argue whether meaningful use gets them using the right features, but as doctors investigate meaningful use they’ll often find EMR features they didn’t realize existed or were too lazy to implement. Many times this helps a doctor become more efficient and enjoy use of their EHR software. Both great things.

New ONC Health IT Website Design

Posted on September 8, 2011 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 don’t know how many of you noticed, but ONC has done a nice redesign of the HealthIT.gov website. Here’s a screenshot for those that don’t want to click through to the site:

Besides the website being a pretty big visual upgrade to the site, I also like the way it’s been simplified and focuses on the two most important parts of the healthcare system: the providers and the patients.

I haven’t dug into all the resources really deeply yet, but at first glance it seems like they have some decent information for those who likely don’t have a deep understanding of healthcare IT and the government EHR incentive money.

Personally I’d have liked to see a little more emphasis on EHR selection as opposed to them skipping straight to the EHR implementation. Sure, many people consider EHR selection part of the EHR implementation, but I see EHR selection as so important that it’s worthy of highlighting separately.

I’ll leave an analysis of the section on Patients and Families to the ePatients out there. I’m sure they’ll be chiming in shortly.

I also love all the social media integration that’s happening on the site. My only problem with government use of social media is that they can’t use it properly most of the time. They’re so restricted on what they can and can’t say that you don’t get the full benefits of social media.

Reasons for EHR Market Failure According to ONC Director Mostashari

Posted on June 16, 2011 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.

In the write up of the Farzad Mostashari closing keynote of the Government Health IT conference in Washington, Tom Sullivan provided the following summary and quote (emphasis mine):

Competition is a wonderful thing, said Mostashari, but “classic causes of market failure,” in this instance prohibitively high switching costs, vendor or data lock-in, among others, weaken the competitive landscape.

“We need to create a better marketplace,” he said. “We want as little government involvement as possible, but no less.”

These two items are worth considering when it comes to an EHR selection and implementation: prohibitively high switching costs and vendor or data lock-in.

I think I might have to write some future posts on these topics and possible other reasons that the EHR market has issues. For example, a clear way to differentiate EMR products seems like another EMR market failure.