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Three Ways AI Can Improve Physicians’ Workflow

Posted on November 26, 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.

For far too many physicians, EHRs and other important health IT seem to get in the way of getting the job done. But according to one pair of physician-authors, emerging AI technology has the potential to improve physician workflow instead.

“We see opportunities for AI to be a solution for—rather than a contributor to—burnout among physicians and achieving the Quadruple Aim of improving health, enhancing the experience of care, reducing cost and attaining joy in work for health professionals,” wrote AMA chief medical information officer Michael Hodgkins, MD, MPH and Shantanu Nundy, MD, director of the Human Diagnosis Project.

In an article for the journal Health Affairs, Drs. Hodgkins and Nundy outlined three ways in which AI could be used to make physicians’ work easier and more satisfying. They include:

  • Delivering educational information to the point of care: At present, most educational efforts targeting physicians don’t do a good job of keeping physicians up to date, as they aren’t targeted enough, the article asserts. However, by using AI, healthcare organizations can offer personalized content to physicians by reviewing their existing research habits. By analyzing practice data, online search queries and assessments, AI can provide a streamlined infostream offering only what they need.
  • Producing clinical documentation: The authors argue that AI will someday be able to complete clinical documentation tasks on the physicians’ behalf. In their view, these AI applications will analyze a given physician’s free-text narrative, extract relevant information and insert the information into the right data fields in their EHR. (Researchers are testing out some concrete approaches for doing this.)
  • Collecting information needed for quality-measurement reporting: Hodgkins and Nundy envision a scenario in which AI tools spare doctors the need to perform hours of redundant quality reporting duties. As in the documentation example, such tools would review clinical documents and extract needed information, though this time in search of meeting external requirements. They would then populate data fields in need of completion on submission forms.

These are comparatively straightforward applications of AI. In addition to the trio of possibilities suggested above, AI could eventually deliver clinical decision support on the fly, speed and improve the accuracy of medical image interpretation and more.

In the meantime, however, it’s hard to disagree with these authors that physicians could benefit a great deal from AI tools that make basic clinical workflow faster and less draining.

Program Gets Rid Of EHR “Stupid Stuff” Flagged By Users

Posted on November 21, 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.

Physicians at Honolulu-based Hawaii Pacific Health were optimistic that they could eliminate at least some of the documentation tasks they performed when using their EHR, which had been in place for more than 10 years,

To identify the changes that needed to be made, Hawaii Pacific launched a program dubbed “Getting Rid of Stupid Stuff” focused on getting rid of anything in EHR which didn’t work. Leaders asked employees to “look at their daily documentation experience and nominate anything in the EHR that they thought was poorly designed, unnecessary, or just plain stupid,” wrote Melinda Ashton, M.D. in a recent letter to the New England Journal of Medicine.

Starting in October 2017, employees began identifying problems with the EHR documentation workflow. These included documentation that was never meant to happen and would be easy to eliminate or fix; documentation that was needed but could be done more efficiently or effectively; and documentation that was needed for which clinicians didn’t understand the need or know about all of the tools available to complete it.

Some of the fixes employees recommended were more-or-less no-brainers, such as removing a requirement that nurses working with adolescent patients assess the cord, a feature which should only have applied to newborn babies.

In another case, the emergency medicine department was able to remove the requirement that clinicians print an after-visit summary, obtain the signature and scan it back in the system after learning that the step wasn’t necessary. The organization also reduced the frequency of required nursing assessments and documentation by nurses, from as many as several times in a 12-hour shift to solely when they assumed care of a patient.

In addition, they learned that Hawaii Pacific needed to do a better job of educating staff about the documentation tools that were available. This need was underscored by the fact that several requests came in from physicians asking for sorting and filtering capabilities to the EHR already possessed. The organization did have a physician-documentation optimization team in place already to help clinicians use the EHR efficiently, but most physicians had said that they didn’t have time to meet with the team.

Along the way, the team decided to remove 10 of the 12 most frequent alerts for physicians because they were being ignored, in addition to reviewing order sets by removing the ones that hadn’t been used recently.

In addition to getting a lot of useful feedback on improving physician workflow in the EHR, the Stupid Stuff program has put a process in place for continuing to improve EHR performance. Over time, it’s been embraced warmly by employees, Ashton reports.

“When the campaign was unveiled, it was largely met with surprise and sheepish laughter, then applause,” Ashton writes. “We seem to have struck a nerve. It appears that there is stupid stuff all around us.”

Stanford Offers 10-Year Vision For EHRs

Posted on October 12, 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.

Despite many efforts to improve EHRs, few physicians see them as adding value to the practice. Sadly, it’s little surprise given that many vendors don’t worry much about what physicians want, focusing instead on selling features to CIOs.

As a result, they still don’t like their EHRs that much. In fact, a recent survey conducted by Stanford Medicine and the Harris Poll found that 44% of physicians said that the top value of the EHR was to serve as digital storage, which isn’t a ringing endorsement. Just eight percent saw the EHR as having clinical value, with three percent citing disease prevention, 2% clinical decision support and 3% patient engagement as top benefits.

Is it possible to create a new EHR model that physicians love? According to Stanford, we could build out an ideal EHR by the year 2028.

In Stanford’s vision, clinicians and other healthcare professionals simply take care of the patients without having to think about health records. Once examinations are complete, information would flow seamlessly to all parties involved, including payers, hospitals, physicians and the patient.

Meanwhile, it would be possible to populate the EHR with little or no effort. For example, an automated physician’s assistant would “listen” to interactions between the doctor and the patient and analyze what was said. Depending on what is said in the room, along with verbal cues of the clinicians, it would record all relevant information in the physical exam.

What’s more, the automated physician’s assistant would have AI capabilities, allowing it to synthesize medical literature, the patient’s history and relevant histories of other patients available in anonymized, aggregated form.

Having reviewed these factors, the system would then populate different possible diagnoses for the clinician to address. The analysis would take patient characteristics into account, including lifestyle, medication history, and genetic makeup.

In addition to its vision, the survey report offered some short-term recommendations on how medical practices can support physician EHR use. They included:

  • Training physicians well on how to use the EHR when they’re coming on board, as well as when there are incremental changes to the system
  • Involving physicians in the development of clinical workflows that take advantage of EHR capabilities
  • Delivering EHR development projects as quickly as possible once physicians request them
  • Making data analytics abilities available to physicians in a manner that can be used intuitively at the point of care
  • Considering automated solutions to eliminate manual EHR documentation

Technologists, for their part, can take also take immediate steps to support physician EHR use, including:

  • Developing systems and product updates in partnership with physicians
  • Limiting the use of manual EHR documentation by using AI, natural language processing and other emerging technologies
  • Using AI to perform several other functions, including synthesizing and summarizing relevant information in the EHR for each patient encounter and offering current and contextualized information to each member of the patient care team

In addition, to boost the value of EHRs over the long-term, 67% of physicians said making interoperability work was important, followed by improving predictive analytics capabilities (43%), and integrating financial information into the EHR to help patients understand care costs (32%).

A Vote In Favor Of Using Scribes

Posted on September 26, 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.

Over the past few years, using scribes to complete medical documentation in EHRs has gotten mixed reviews. Some analyses have found that scribe services were too expensive to justify the investment, while others have concluded that the use of scribes can make a meaningful impact on revenue and improve physician productivity.

This month, a new paper has been published whose results fall into the plus column. The small study, which appears in JAMA Internal Medicine, looked at the use of scribes among 18 primary care physicians.

To conduct the study, researchers looked at physicians at two medical center facilities within an integrated healthcare system, gathering data between July 1, 2016 and June 30, 2017.

The research team assigned PCPs randomly to two groups, one with and the without scribes, for 3-month periods, switching physicians between the with and without groups every three months. At the end of each three-month period, the PCPs filled out a six-question survey which collected their perceptions of documentation burdens and visit interactions.

In addition to capturing PCP perceptions of scribe use, researchers also collected objective data, including time spent on EHR activity. They also surveyed patients of participating PCPs to gather data on the patients’ perceptions of visit quality.

When all was said and done, the research team found that scribed periods were associated with less self-reported after-hours EHR documentation work.

Researchers also found that when they used scribes, PCPs were more likely to report spending more than 75% of the visit interacting with the patient and less than 25% of the visit on the computer. In addition, physicians were more likely to finish their encounter documentation by the end of the next business day during scribed periods.

What’s more, 62.4% of patients said that scribes had a positive effect on the visits, while just 2.4% said they had a negative effect.

The researchers’ take away from all this was that the use of medical scribes could be one strategy for improving physician workflow and primary care visit quality.

As I noted previously, other research has drawn similar conclusions. For example, a study published in 2015 (which included the involvement of scribe provider ScribeAmerica) found that scribe use at the two hospitals was linked to an improved Case Mix Index which ultimately led to gains of about $12,000 per patient. Meanwhile, inpatient physicians were able to cut time spent the chart updates by about 10 minutes per patient on average.

Having been over arguments for and against scribe use, my personal conclusion is that working with them can be a worthwhile investment if doing so is a good fit for the physicians involved, but doesn’t work in all cases.

Ultimately, it seems that there’s too much variation between settings in which scribes could be used to make a single blanket statement about their benefits. I guess we won’t be drawing grand conclusions about scribe pros and cons anytime soon.

Physicians Are (Justfiably) Ambivalent About Virtual Care

Posted on July 30, 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.

It’s easy for pundits like myself to support virtual care. From my standpoint, it’s obvious that virtual care is the easiest and most effective way to handle many health conditions, from handling one-off issues like sore throats and sinusitis to managing long-term chronic conditions.

Not only that, emerging devices will allow patients to test their own blood, urine, heart rhythm and more. When these devices are perfected and put into common use, virtual care will become even more useful and appropriate.

Despite all of these signs of progress, though, physicians aren’t all in with virtual care just yet. According to a study by consulting firm Deloitte, doctors think virtual care might help with patient engagement and support. However, doctors said they would need to overcome several obstacles to virtual care use before they get involved.

Generally speaking, survey respondents seem to “get it” about telemedicine. In fact, according to the survey nine in 10 physicians understand the benefits of virtual care, particularly when it came to connecting with patients. They reported that these benefits include improved patient access to care (66%), increased patient satisfaction (52%) and staying connected with patients and their caregivers (45%).

They also said virtual care could improve patient care coordination (42%), boost the cost-effectiveness of care (42%), offer increased flexibility to clinician schedules (41%), streamline workflow (32%) and help them stay connected with peers and other clinicians (28%). Only 11% said they didn’t see any benefits to virtual care.

Given these advantages, you might think that physicians were gung-ho about virtual care adoption – but you’d be wrong. Just over a third (38%) have rolled out email/patient portal consultations, and 17% are conducting physician-to-physician electronic consultations. Only 14% are conducting virtual/video visits.

On a side note, I was interested to learn adoption of such technologies is higher among primary care physicians than specialists. The survey found that 48% of primary care physicians have implemented portals, compared with 34% of specialists, and that 17% of PCPs were offering video visits versus 13% of specialists.

Meanwhile, I was interested to learn that 43% of respondents who had electronic consultation tools at their disposal connected with colleagues at least once a week. In fact, I’m surprised to learn that this is even happening– electronic consults with between doctors and their peers was not on my radar.

But I wasn’t taken aback to learn that physicians employed or affiliated with hospitals and health systems (62%) made regular use of at least one virtual care technology. After all, hospitals are generally ahead of other providers when it comes to telemedicine. (For example, check out Intermountain’s virtual hospital program.)

Bottom line, physicians still face big obstacles to rolling out virtual care, including a need for training (51%), a lack of access to this technology (35%) and worries about security and privacy of patient data (33%).

All told, when I read about their reasonable objections, low physician adoption of virtual care makes a whole lot more sense. Until these concerns are addressed little is likely to change.

This Futurist Says AI Will Never Replace Physicians

Posted on June 6, 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.

Most of us would agree that AI technology has amazing — almost frightening — potential to change the healthcare world. The thing is, no one is exactly sure what form those changes will take, and some fear that AI technologies will make their work obsolete. Doctors, in particular, worry that AI will undercut their decision-making process or even take their jobs.

Their fears are not entirely misplaced. Vendors in the healthcare AI world insist that their products are intended solely to support care, but of course, they need to say that. It’s not surprising that doctors fret as AI software starts to diagnose conditions, triage patients and perform radiology readings.

But according to medical futurist Bertalan Mesko, MD, Ph.D., physicians have nothing to worry about. “AI will transform the meaning of what it means to be a doctor; some tasks will disappear while others will be added to the work routine,” Mesko writes. “However, there will never be a situation where the embodiment of automation, either a robot or an algorithm, will take the place of a doctor.”

In the article, Mesko lists five reasons why he takes this position:

  1. Empathy is irreplaceable: “Even if the array of technologies will offer brilliant solutions, it would be difficult for them to mimic empathy,” he argues. “… We will need doctors holding our hands while telling us about life-changing diagnoses, their guide to therapy and their overall support.”
  2. Physicians think creatively: “Although data, measurements and quantitative analytics are a crucial part of a doctor’s work…setting up a diagnosis and treating a patient is not a linear process. It requires creativity and problem-solving skills that algorithms and robots will ever have,” he says.
  3. Digital technologies are just tools: “It’s only doctors together with their patients who can choose [treatments], and only physicians can evaluate whether the smart algorithm came up with potentially useful suggestions,” Mesko writes.
  4. AI can’t do everything: “There are responsibilities and duties which technologies cannot perform,” he argues. “… There will always be tasks where humans will be faster, more reliable — or cheaper than technology.”
  5. AI tech isn’t competing with humans: “Technology will help bring medical professionals towards a more efficient, less error-prone and more seamless healthcare,” he says. “… The physician will have more time for the patient, the doctor can enjoy his work in healthcare will move into an overall positive direction.”

I don’t have much to add to his analysis. I largely agree with what he has to say.

I do think he may be wrong about the world needing physicians to make all diagnoses – after all, a sophisticated AI tool could access millions of data points in making patient care recommendations. However, I don’t think the need for human contact will ever go away.

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.

AI Tool Helps Physician Group Manage Prescription Refills

Posted on April 25, 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.

Most of the time, when we hear about AI projects people are talking about massive efforts spanning millions of records and many thousands of patients. A recent blog item, however, suggests that AI can be used to improve comparatively modest problems faced by physician groups as well.

The case profiled in the blog involves Western Massachusetts-based Valley Medical Group, which is using machine learning to manage medication refills. The group, which includes 115 providers across four centers, implemented a product known as Charlie, a cloud-based tool made by Healthfinch 18 months ago. (I should note, at this point, that the blog maintained is by athenaHealth, which probably has a partnership with Healthfinch. Moving on…)

Charlie is a cloud-based tool which automates the process of prescription refills by integrating with EHRs. Charlie processes refill requests much like a physician or pharmacist would, but more quickly and probably more thoroughly as well.

According to the blog item, Charlie pulls in refill requests from the practice’s EHR then adds relevant patient data to the requests. After doing so, Charlie then runs the requests through an evidence-based rules engine to detect whether the request is in protocol or out of protocol. It also detects duplicates. errors and other problems. Charlie can also absorb specific protocols which let it know what to look for in each refill request it processes.

After 18 months, Valley’s refill process is far more efficient. Of the 10,000 refill requests that Valley gets every month, 60% are handled by a clerical person and don’t involve a clinician. In addition, clerical staff workloads have been cut in half, according to the practice’s manager of healthcare informatics.

Another benefit Valley saw from rolling out Charlie with that they found out which certain problems lay. For example, practice leaders found out that 20% of monthly refill requests were duplicate requests. Prior to implementing the new tool, practice staff spent a lot of time investigating the requests or worse, filling them by accident.

This type of technology will probably do a lot for medium-sized to larger practices, but smaller ones probably can’t afford to invest in this kind of technology. I have no idea what Healthfinch charges for Charlie, but I doubt it’s cheap, and I’m guessing its competitors are charging a bundle for this stuff as well. What’s more, as I saw at #HIMSS18, vendors are still struggling to define the right AI posture and product roadmap, so even if you have a lot of cash buying AI is still a somewhat risky play.

Still, if you’re part of a small practice that’s rethinking its IT strategy, it’s good to know that technologies like Charlie exist. I have little doubt that over time — perhaps fairly soon — vendors will begin offering AI tools that your practice can afford. In the meantime, it wouldn’t hurt to identify processes which seem to be wasting a lot of time or failing to get good results. That way, when an affordable tool comes along to help you’ll be ready to go.

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.

Three-Quarters Of Medical Practices Aren’t Getting Full Value From Their EHR

Posted on February 6, 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.

Given how many EHRs seem to feature position-hostile designs, it’s hardly surprising to learn that many medical practices aren’t getting the most from them. However, I was taken aback by how deep this underutilization seems to run.

A new study appearing in the American Journal of Managed Care has concluded that a whopping 73% of practices weren’t using their EHRs to the fullest extent and that another 40% make little or no use of health IT functions. Even given the obstacles to using EHRs, this seems like a big waste of money, time and potential, doesn’t it?

To conduct the study, researchers used data from a relevant HIMSS Analytics survey. The data included responses from 30,123 ambulatory practices with an operational EHR in place, most with fewer than seven affiliated doctors in place.  Researchers sifted the data to determine the extent to which these practices were using EHR-based health IT functionalities.

Of course, some medical groups were on top of their game. Researchers found that 26.6% of practices could be classified as health IT super-users that squeezed every benefit from their systems. As you might guess, the likelihood that a practice was a super-user grew as the number of affiliate doctors increased, as well as when the practice was located in a metropolitan area. But far more groups seem to have fallen well behind the leaders.

According to the data, among practices using CPOE tools, only 36% used them for more than 75% of orders. Also, while groups commonly used basic functions such as data storage, with 100% of practices storing transcribed reports electronically and 61% using the EHR for nursing documentation, most lagged in other areas. For example, only 29% used tools allowing them to find and modified orders for all patients on a specific medication.

To address this gap, researchers say, policymakers should consider how to address the barriers PCP and specialist practices face in using the health IT tools more fully. Understanding how this disparity has emerged and how to address it is critical, they suggest, as less sophisticated use of EHRs may have an impact on care quality and also on groups’ ability to participate in community efforts such as HIEs.

The truth is, if the under-utilizer practices don’t get some kind of help or support, it’s unlikely they’ll step up their use of EHR functions. Particularly if they’ve had the system in place for a while, the workflow is baked into the system and physician habits established. Maybe the pressure to provide value-based care will do the trick, but it remains to be seen. This is a problem that won’t go away quickly.