Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

Ophthalmologists Worry That EHRs Decrease Productivity, Boost Costs

Posted on January 16, 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.

A new study has concluded that while EHR use among ophthalmologists has shot up over the last decade, most of these doctors see the systems as lowering their productivity and increasing their office costs, according to a survey published in JAMA Ophthalmology.

To conduct the study, the researchers emailed surveys to 2,000 ophthalmologists between 2015 and 2016. The 2,000 respondents, whose responses were anonymous, were chosen out of more than 18,000 active US members of the American Academy of Ophthalmology.

The researchers involved found that the EHR adoption rate for ophthalmologists, which is about 72.1%, was similar to rates among other specialties. Nonetheless, it’s a big jump from 2011, when only 47% of the 492 respondents reported using EHRs in their practice.

Most respondents were devoted solely to ophthalmology and had an average of 22 years of practice. They had an average of 5.3 years of EHR use, but nearly the entire group had previously used paper records. Eighty-eight percent of those currently using EHRs had been present for the transition from paper records to digital ones, researchers found.

Not surprisingly, given typical EHR acquisition and maintenance costs, the mean number of ophthalmologists in a given practice was higher among those with an EHR in place than practices without one. Researchers found that when practices were part of an integrated health system, a government health system, the higher the odds of their having adopted an EHR.

While the adoption rate has increased, ophthalmologists actually seem less happy with EHRs than they had been before. For example, many reported that they felt EHRs were undermining both their productivity and financial situation.

For example, more than half of respondents in 2016 reported that their patients seen per day had fallen since adopting EHRs. That’s an unfortunate change in perceptions since in 2006, more than 60% of ophthalmologists saw an increase in productivity after their EHR system was implemented.

Meanwhile, respondents were ambivalent about the impact of EHR use on revenue, with 35% reporting that revenue had remained the same after adoption, 41% a decrease and almost 9% an increase.

Despite concerns that EHRs were undercutting practice productivity, researchers reported that three previous studies of academic ophthalmology practices found no change in patient volume after EHR adoption.

There also seems to be a disconnect between what ophthalmologists think their patients want technically and what they want.  While 76% reported that their patients felt mostly positive or neutral toward EHR use, 36% of ophthalmologists would return to paper records if they had the chance.

That being said, ophthalmology practices do seem to see the benefits in keeping their EHR systems in place. For example, despite the fact that 68% saw paper documentation as faster, 53% of respondents felt their EHRs were generating net positive value.

All told, it seems that ophthalmologists’ concerns about EHR use are working themselves out. However, it also seems as though the doubts we see documented here are deeply rooted and may not go away quickly.

Apple EHR

Posted on December 11, 2015 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 love how everyone thinks that Apple touching something will somehow make it better. Not only does this forget about the various times Apple has had product fails, but it also assumes that Apple can fix everything. It’s possible that’s what’s broken with EHR is the system and not the people creating the software itself. In fact, that’s what many innovators and startup entrepreneurs see when they look at healthcare and then choose to stay away.

I read a quote from a VC recently that said something similar to this, “When you go into a market you expect it to act in a certain way. Healthcare doesn’t act like a rational market.”

Chew on that concept a little. However, the final part of the above tweet is what really gets under my skin. “Ability to customize every single deployed copy!” People who ask for this don’t really know what they want and it’s also not fair to say that everything on the iPhone, for example, can by customized. Turns out that most people that get an iPhone or iPad do very little customization. The out of the box experience is really quite incredible with very little customization required.

We’ve written about this before back in 2010. Software vendors have to find the right balance between a beautifully simple and effective “out of the box” experience and the long term ability to customize the EHR in any form or fashion they desire.

I’m sure all the hospital CIOs reading this are shaking their heads when I talk about the “out of the box” experience being great. When they look at the millions (sometimes hundreds of millions or even billions) that they’ve spent on EHR consultants to configure and customize their EHR software, they could clearly argue that their hospital EHR has the “ability to customize every single deployed copy.” In fact, it costs them millions of dollars to get it customized. I’ve heard many hospital CIOs wonder why their EHR needs so much configuration. In the ambulatory world you can get much closer to an out of the box experience. Although, even they like to complain about there being too much EHR configuration.

This conversation is actually going to get even more complex. When you look at evidence based medicine and various care guidelines, there’s a movement to try and standardize some of the ways we practice medicine. I’m reminded of when I heard the CMIO of Intermountain say, “If we allow physicians to do whatever they want, we’re allowing them the right to take improper care of patients.” This is going to drive organizations to use a much more standards based workflow as opposed to their own unique customizations.

Finding the balance between infinitely customizable and hard coding proper workflows is an extremely hard problem to solve and will likely never be fully solved. However, it’s the challenge of any software system.

As far as Apple doing an EHR or as one person suggested, Apple buying an EHR vendor…that’s never going to happen. Just look at how simple their approach to Apple Health Kit has been. They’re not going to tackle the true problems of healthcare.

What I do think Dino was trying to say in the tweet above is “I wish I loved my EHR as much as I love my Apple products.” Now that’s a concept I can get behind and would be a great aspiration for every EHR vendor.

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.

Doctor Quits Practice Over EHR Use

Posted on May 5, 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 got sent this interesting article that starts by talking about a doctor who leaves his medical practice because of the 3 physician group’s EHR system. The complaint being that patient wait times were 1-2 hours. The major problem seems his inability to type and to learn the new system.

Did no one offer this doctor a scribe or voice recognition (although this would have probably even been harder for him) to make his EHR use easier?

Reminds me of the opposite side of the coin as well. A medical student friend of mine hates when he has a rotation in a practice that doesn’t have an EMR. Mostly because he can type so much faster than he can write.