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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.

All I Want for Christmas is a Doctor’s Appointment

Posted on December 20, 2013 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.

A friend of mine had a very timely – and telling – prayer request at church the other day. She asked the Lord to help those in need of doctor’s appointments make them in a timely manner, both in terms of receiving care soon, and getting face time with a doctor before insurance deductibles roll over or cancelled policies end. It’s a prayer I’m sure many patients have been uttering just before they pick up the phone to see when their doctor’s next available appointment is; one that is all the more urgent for those with chronic conditions.

I have based past decisions on which new doctor to use based on their window of open appointments. Can’t see me for three weeks? Then you don’t get my business. Time is of the essence in healthcare these days. Patients want doctors’ time, and doctors don’t seem to have enough to go around. (Nor do they feel adequately compensated for it.)  Healthcare IT – patient portals, CPOE, natural-language processing systems, etc. – is certainly playing a role in helping doctors and ancillary staff get back some of that time. (Though many doctors contend entering data into EMRs is eating up a lot of that time savings.)

Some have postulated that healthcare IT, particularly digital health tools, will actually cause us to need doctors less. This counters the notion that we will soon see (if we aren’t already) a physician shortage, and an even greater lack of appointment availability thanks to the 27 million newly insured who will take advantage of their new policies in 2014. I’m not quite convinced that digital health devices and apps will cause me to go to the doctor any less. They may make the waiting in between my appointments less anxiety inducing, but I know myself too well to think I’d ever scale back on face time with my doctor. Perhaps those with chronic conditions feel differently. I’d be open to telemedicine and virtual visits, but those don’t seem to be on the radar of providers in my area.

Healthcare IT can certainly save time and improve access to care, but I don’t see how it can convince people to enter the healthcare field, which is where the true appointment availability problem seems to stem from. As a recent article at HealthcareFinanceNews.com points out, “retirement age physicians outnumber young members entering the ranks; over-worked physicians want to reduce their hours and care for fewer patients; and [there is a] general disenchantment with the state of healthcare.”

It’s a sad state of affairs when put that way. So what’s the answer? How can the healthcare industry – healthcare IT in particular –  work to ensure that prayers for timely appointment availability are no longer routine? Feel free to share your ideas in the comments below.

Hardest Meaningful Use Measure

Posted on December 21, 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.

There was a great piece a while back by Benjamin Harris that looked at the 5 not-so-easy pieces of meaningful use stage 2. In the article he suggests the following 5 challenges:

1. Structured Lab Results
2. Patient Access to Health Information
3. Ongoing Submission to Registries
4. Computerized Order Entry (CPOE)
5. Summary of Care Referrals

I started asking around my network to see what readers of my site and those in my social media groups thought was the hardest meaningful use measure for them. Some of them match the list above, but I thought I’d highlight a few of them I found interesting.

One person told me that the multi-lab scenario might be one of the most challenging parts of meaningful use and one that doesn’t get talked about much.

A CIO named Renee Davis told me that ePrescribing and monitoring compliance were the hardest meaningful use measures. I think the ePrescribing part can be a huge challenge depending on your EHR vendor, your physician users, and your location (ie. Do your local pharmacies participate?). Plus, any CIO will definitely have challenges with compliance.

Patty Houghton suggested that Clinical Summaries and Problem Lists were her hardest meaningful use challenges.

Obviously when you say the word “hardest” it’s something that’s unique to an individual practice or institution. With that disclaimer, from the large number of people I’ve talked to I think that most people consider the 60% CPOE meaningful use measure the hardest.

I still remember the day when I heard Marc Probst, CIO of Intermountain Healthcare (IHC), say that IHC was doing ) CPOE. This was when he was first working on the committees in Washington to create EHR certification and meaningful use requirements. It was a shock to me that IHC, who is touted for its use of IT in healthcare, could have 0 CPOE (I think Meaningful Use has helped encourage them to remedy this number). It illustrated well how much of a challenge CPOE will be for many institutions.

What’s your experience and the experience of the doctors and hospitals you work with? Which meaningful use measures are most challenging?

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.

101 Tips to Make Your EMR and EHR More Useful – EHR Tips 31-35

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.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

35. CPOE is important, but every EMR will have it.
I think that the CPOE discussion hit a head for me when I saw the CPOE requirements that were baked into meaningful use. Then, I heard someone from the often lauded (appropriately so) IHC in Utah who said that IHC didn’t have CPOE and it would be hard for them to meet that benchmark. Ok, so I’m more of an ambulatory guy than I am hospital, but this surprised me. In the clinics I’ve helped with EHR, CPOE is one of the first things we implemented. No doubt that every EMR has CPOE capabilities.

34. Make sure adverse drug events reporting is comprehensive
Yes, not all drug to drug, drug to allergy, etc databases are created equal. Not to mention some EHR vendors haven’t actually implemented these features (although, MU is changing that). I’d really love for a doctor and an EMR company to go through and rate the various drug database companies. How comprehensive are they? How good can you integrate them into your EHR? etc etc etc.

33. Make certain drug interactions are easy to manage for the physician
I won’t go into all the details of alert fatigue in detail. Let’s just summarize it this way: You must find the balance between when to alert, what to alert, how to alert and how to ignore the alert. Plus, all of the opposites of when not to alert, what not to alert, and how to not ignore the alert.

32. Ensure integration to other products is possible
Is it possible that you could buy an EMR with no integration? Possibly, but I have yet to see it. At a bare minimum clinics are going to want to have integration with lab software and ePrescribing (pharmacies). That doesn’t include many of the other common interfaces such as integration with practice management systems, hospitals, radiology, etc. How well your EMR handles these integration situations can really impact the enjoyment of your EHR.

31. Ensure information sharing is easy
This tip could definitely be argued, but I believe we’re headed down the road of information sharing. It’s going to still take a while to get to the nirvana of information sharing, but we’ve started down the road and there’s no turning back. Kind of reminds me of Splash Mountain at Disneyland where the rabbit has a sign that says there’s no turning back now. My son didn’t like that sign so much and I’m sure many people won’t like that there’s no turning back on data sharing either. However, it’s going to happen.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

Healthcare IT Market Grows to $162.2 Billion in 2015

Posted on September 13, 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 found this EMR and Healthcare IT forecast pretty interesting. That’s a pretty big market. Here’s an interesting bit about the growth of sections of the healthcare IT market:

EMR is expected to the highest growing market with a CAGR of 16.7% from 2010 to 2015. CPOE is also a fast growing segment with a CAGR of 16.5% from 2010 to 2015. Point of care information systems, specialty care information systems (cardiovascular information systems, oncology information systems), surgical and intensive care information systems are expected to have a combined CAGR of 15.1% from 2010 to 2015.

They also assert in the report that Meditech (U.S.), Cerner Corporation (U.S.), Mckesson Corporation (U.S.), Siemens Healthcare (Germany), Epic Systems (U.S), Allscripts (U.S.), Philips (The Netherlands), and GE Healthcare (U.S.) account for the majority of the market.

Neil Versel on Meaningful Health IT News

Posted on August 24, 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’ve been really intrigued by a number of the articles written by the famous healthcare IT journalist, Neil Versel on his site Meaningful Health IT News (Note: I host his blog, but he creates all the content). Here’s a few of his interesting posts and my thoughts about them.

Founder of Twitter, Biz Stone to Speak at HIMSS 2012 – I think this is really exciting. I’m interested to hear what he’ll say about healthcare. I’m not sure how much he’ll mention Twitter, but he’s got a smart mind and I love listening to smart people.

I’d love for Biz to take questions from Twitter during the event too. He also helped create and launch blogger. Maybe we could convince Biz Stone to come to the 3rd Annual New Media Meetup at HIMSS 2012.

BTW, @HIMSS got Biz Stone’s Twitter handle wrong. He’s @Biz.

CPOE Cartoons – Everyone needs a good laugh. So, I enjoyed these cartoons which make light of the idea that doctors might just search Google for the answers. Of course they won’t, but that doesn’t change the fact that doctors of the future will have amazing resources online to help them treat patients better than they do now.

Neil also mentioned the passing of Bernadine Healy and Janice Simmons. My condolences go out to both their families. Janice did something similar at FierceEMR to what I do on here. It’s a stark reminder that life is short. I’ve had it on my mind lately since last week my wife and I created a Trust and last night I finally put together the information about all my websites for my wife should something happen to me. Here’s hoping that she never needs that information, but I feel much better knowing she has it.

New HIMSS CPOE Wiki Illustrates Complexity

Posted on November 10, 2010 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.

Today, I got an email about the new HIMSS CPOE wiki that was just launched. I barely want to link to it since it makes me laugh. Plus, it’s not a true wiki since only members that have been approved can edit the wiki. It’s not open like the EMR and HIPAA wiki and other real wiki pages. That said, if you still want to take a look, here’s the link.

To be honest, I haven’t looked through much of the information on the wiki. First, because I was turned off by my inability to be able to edit the wiki if I saw fit. Second, because I saw this diagram on the main page which completely turned me off to it.

Here’s the diagram (click on it to see the full size image):

My blood pressure starts to rise just looking at the diagram. The number of lines that cross over with arrows going every which way is hard to follow. There are two starting points and no clear end point. It’s amazing the complexity they’ve put into what should be a clear diagram that tells a simple story. I should mention that the diagram is suppose to be the navigation diagram for the wiki, but it seems like their plan was for the navigation to be a model for someone going through the steps of a CPOE implementation.

Is there any wonder why CPOE hasn’t been implemented? Although, I can’t help but wonder if CPOE is this complex to implement or whether the people creating the diagram are what made the CPOE implementation so complex.

Maybe I should ask some of the CPOE workgroup members. After all, there names and emails are available to anyone on this page of the wiki.

I would have commented on the wiki itself since it says it has the capability for commenting. Only problem is that it says, “You don’t have permission to comment on this page.” Oh well, at least I have a blog where I can comment.