MGMA Study Reveals #1 Reason Physicians Fear EHRs

The evidence is indisputable: the fear of lost productivity associated with EHR implementation is uppermost in the minds of physicians, and their fears are justified by the actual experience of the majority of EHR adopters to date. The titles of two articles about the recently released MGMA EHR survey say it all: “Survey: EHRs Often Don’t Increase Doc Productivity” (Health Data Management) and “HITECH Drives Docs to EHRs, but Cost, Productivity Issues Remain” (Healthcare IT News).

MGMA is to be commended for the size and scope of this important survey (4,588 practices representing 120,000 physicians), for the multiple ways it segmented the survey population, and for the detailed analysis of the results. One important segmentation was missing, however—that of physician specialty, or, at a minimum, of primary care versus specialist. The EHR experience of orthopaedists or ophthalmologists, who may see as many as 60 patients a day, is dramatically different from that of a family practice physician who sees 20.

Productivity was the pervasive issue. The only group that reported some productivity gains was the 16.3% self-proclaimed “optimized users” of EHRs—those who have had sufficient time following implementation to master the EHR. (The report did not define “sufficient time.”) Among this group, 41% reported that physician productivity has increased. What is disturbing about this statistic, however, is the implication of the converse—that even among these most accomplished EHR users, the majority of physicians (59%) are seeing a decrease, or at best no increase, in productivity. For the total population studied, 43% have just worked their way back up to where they were before implementation, and 31% of respondents are experiencing an actual productivity decrease.

Productivity was the major factor accounting for why 8% of survey participants are in the process of replacing their EHR with another, while anticipated productivity loss was reported as the most significant barrier to EHR implementation for physicians still using paper charts. Among these paper users, 78% fear productivity loss during implementation and 67% worry about the effect even after the transition to an EHR.

This data confirms past experience regarding productivity loss and raises these critical questions:

  • Why do only 16.3% of EHR owners categorize themselves as “optimizing their use of an EHR”?
  • While government incentives will certainly address the financing concerns expressed by small practices, how will this money address the productivity obstacle for all adopters?
  • What accounts for the loss of productivity?
  • When technology has replaced an antiquated paper process in other industries, it has always brought increases in productivity. How do we deliver the same results in healthcare?

The MGMA report did not tie satisfaction and productivity to the particular EHR being used, but there were clearly some successes, so it is important to understand what differentiates these implementations. It all comes down to usability. According to a recent HIMSS Task Force Report on why adoption has been so slow, “A key reason, aside from initial costs and lost productivity during EMR implementation, is lack of efficiency and usability of EMRs currently available.” I maintain that lost productivity and lack of usability are one and the same.

8 Responses to “MGMA Study Reveals #1 Reason Physicians Fear EHRs”

  1. Loss of productivity is certainly a huge concern. I believe that for EMR’s to be effective, the EMR has to duplicate the paper chart. The drop down tablets do not necessarily address all of the issues that face different Practices and specialties. The cost is high for those who do not qualify for any of the deductions offered thru the definition of meaningful use. Hopefully, EMR’s will improve as more doctors use them and programmers perfect them.
    Thank you.
    AMB

  2. JF Barakeh April 7, 2011

    The reason productivity increases with digitization in other industries is very likely that other industries are able to select and use products based on their needs and costs. In the case of EMR, the product is designed and actually selected by third parties based on THEIR needs and requirements, which we are obligated to fulfill, regardless of OUR needs and costs. Until we as doctors remove the constraints which we have allowed third parties to place upon us, we will continue to bear the costs of such mandates, and government- or insurance company-approved EMR will never improve physician productivity.

  3. Another reason for the productivity hit is that the chief producer (physician) is the entry vehicle for the EMR. In other businesses automation makes it easier for lower level producers (McDonald counter folk) to enter data that gives inventory information, correct charge, and change information. Sort of upside down from asking a physician to work the counter.

  4. Robert M. Miller, MD April 8, 2011

    When I interview, and examine patients I cannot follow charts, dropdowns, etc. My questions, and findings lead to other questions and searches. My findings often do not fit into neat little diagrams or algorithims. The only way I can enter them into my notes is via my own scribbles.
    I must enter my findings at the time of the exam. Afterwards I might forget something. Also typing or dictating or filling out blanks divorces me from the patient, making him or her feel like an object rather than part of the process. It is also simply rude.
    If losing a percent or two to penalties then so be it. I will not sacrifice a good exam for the sake of filling out a questionaire.
    Also, as implied in Dr. Barakeh’s comments. Third party payment is the biggest culpret in the dumbing down of medical care. The patients no longer have very much say in their health care. This needs to be strongly addressed. He who pays the piper calls the tune.

  5. Dr. Miller makes an excellent point about “…filling out blanks divorces me from the patient.” There are so many observations we miss if we are looking at the screen and filling in blanks, selecting drop-down choices, or free typing. Having a scribe solves this issue if it is not cost prohibitive and the scribe is very skilled to allow the examiner to focus on the exam and dictate the EMR entries. But the productivity issues for high volume specialties will be difficult to overcome, so the real cost is not the cost of the system and yearly maintenance but the decrease in productivity plus the checks that are written for hardware, software, and services. Plus, the medical record staff will be replaced by more expensive low and intermediate level IT staff. The inter-connectivity with other systems is not yet where it needs to be. So, waiting for the best system is superior to prematurely choosing one now that is not the best fit even if it is partially paid for by stimulus money. It makes no difference who pays for it if it is a bad purchase! And, then you still have to go through the process with another system. The time has not yet arrived.

  6. The study is really very informative and interesting to read, thanks for sharing about EMR, great work.

  7. IKTodd, PA-C May 27, 2011

    The EMR is so good, I can see 1/2 as many people, in twice the time.

  8. Why is physician productivity the ultimate goal? Should it not be patient care? Can’t the physician slow down and use the EMR properly to produce a better patient record and better patient care simultaneously?

    [Evan Steele Says]
    I’ve always maintained that a more productive physician / practice will do a much better job at taking care of patients. The same holds true for any industry – efficiency results in better customer service/care.

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