Physician EHR Productivity: Vital to Meet Spike in Demand for Care

Half of the physician group practices recently surveyed expected to buy an EHR system within the next 2 years. In the rush to purchase, however, it is imperative that physicians take the time to carefully assess how each of the EHRs they are considering will impact their productivity. Productivity has always been a major concern in EHR adoption, but demographics and financial factors now conspire to make it increasingly critical. Physicians can no longer afford even the slightest decrease in productivity. Consider the following projections that affect specialists:

  • The demand for joint replacement surgery will soon outstrip the supply of orthopaedic surgeons available to provide it, according to studies presented to AAOS. This is partly the result of an aging population with increasing rates of obesity and arthritis, but the growing demand will also come from a younger population. A full 50% of joint replacements will be sought by people under 65—the physically active baby boomer generation with a high level of physical activity. Not only will first-time joint replacements increase astronomically (rising 673% to 3.48 million knee replacements, and 174% to 572,000 hip replacements by 2030), but the demand for revision joint replacements, (i.e., repair or replacement of artificial joints) will also increase—doubling by 2015.
  • The situation is similar for ophthalmologists. Higher life expectancy will create a demand for 30 million cataract surgeries by 2020. Combined with the downward pressure on Medicare reimbursement rates that will lead some ophthalmologists to limit their practices to medical ophthalmology, the result will be a greater caseload for the remaining surgeons—but these physicians will need a high-volume, highly productive practice to remain financially viable.
  • Dermatologists will see a two- to three-fold increase in skin cancer patients as the population ages, and the demands for their medical services will grow rapidly. Not only will dermatologists be called upon to perform more surgical procedures in their offices, but increased awareness will lead to a higher demand for screening and preventive-care services.

Physician productivity will be critical in the office as well as the operating room, since the number of surgeries performed is directly proportional to the number of office visits conducted. A physician-focused, specialist-oriented, efficient EHR will be key to a physician’s ability to meet the increased demands, satisfy patient needs, and run a financially successful practice. Given the above statistics, it would be fiscally and socially irresponsible to implement an EHR that negatively impacts physician productivity. Now, more than ever, productivity is king.

EMR Ratings: A KLAS Act (Part 2)

Last week, I discussed the merits of the new KLAS Performance Report that categorizes EMR ratings based upon practice specialty. The industry has responded very positively to this major step forward, and I suspect that KLAS has received many requests for access to the publication.

One of the obstacles that KLAS faced in reporting by specialty was a lack of sufficient data in many of the categories and for many of the vendors. This data limitation leads me to several initial observations and raises important questions:

  • While there are 27 vendors rated in the primary-care section and 20 in family practice, there are only 2 vendors in ophthalmology, 3 in orthopaedics, and 5 in cardiology with sufficient volume to merit inclusion. Why is that? EMR vendors have been marketing to the specialty physicians for well over a decade. Does this confirm that traditional EMRs have only had real traction in primary care after all these years?
  • A disclaimer by KLAS says that vendors may be excluded from a category due to insufficient data points, yet I know from my own company’s sales experience that there are vendors who claim a large number of installs in specialty practices. Why are these practices not included in the survey results? Did they de-install their EMR? Did the implementation fail, or are the providers not really using the EMR so they chose not to respond to KLAS? Did vendors not supply KLAS with a sufficient number of specialists due to such problems? Whatever the reasons, the lack of responses from specialists is not surprising, given the dearth of specialists’ testimonials or EMR success stories on vendor websites and on industry and government blogs.
  • Some of the vendors that are not rated highly by clients in the specialty categories received significantly better KLAS ratings from their primary-care clients. This data validates the tremendous difference between the EMR needs of specialists and those of primary-care physicians, as I have discussed in numerous posts. The fact that traditional EMRs are designed to meet the needs of primary-care physicians was a concern echoed by the American Academy of Orthopaedic Surgeons in its EMR Position Statement, which said that the primary-care focus “can limit the utility of EHRs for specialty surgical practice.” Force-fitting an EMR designed for primary care into a specialty practice is what has resulted in the historically high failure rate of EMRs among specialists.

Limitations of the data notwithstanding, one conclusion is inescapable: The KLAS report is a great first step in providing specialists with considerably more information than they had prior to its publication, but the burden still remains on the specialists to do their due diligence to identify an EMR with proven success in their specialty.

The High-Performance Physician

Two weeks ago, I described the hybrid EMR as a high-performance EMR, designed for and successful in high-performance practices. This has spurred conversations about the characteristics of high-performance practices, and why their needs for EMR technology differ so greatly from those of other practices.

There are two primary characteristics that differentiate physicians depending on their specialties—patient volume and total financial value of each office visit. Patient volume varies widely since the number of patients seen per day can vary from fewer than 15 for hospital-based, non-fee-for-service physicians to over 30 for pediatricians and dermatologists, and even far higher for many specialists such as orthopaedists and ophthalmologists. The total value of each office visit also varies widely, especially when adding in ancillary tests, procedures, and surgeries that may accompany office visits. Whereas the typical family practice physician generates less than $80 in total revenue per visit, ophthalmologists and orthopaedic surgeons can generate well over $200 per visit.

The High Performance Physician

This chart compares patient volume and revenue characteristics among different types of physicians. High-performance physicians are those who see a high volume of patients and/or generate significant revenue per visit. The orange shaded area of the chart highlights the high-performance specialties: orthopaedics and ophthalmology are high on both scales; OB/GYN is moderate in volume, but high in revenue due to in-house ancillary tests and surgeries; and cardiology is lower in volume but generates high revenue due to the battery of diagnostic tests that stem from many exams. It is these high-performance physicians who, despite having the financial wherewithal to purchase a traditional EMR system, have the lowest adoption rates of those systems.

This chart is by no means an evaluation of the quality or importance of the care physicians provide; rather, it’s a measure of the intensity of their practices, which is why their needs for electronic medical records solutions differ greatly. Traditional (CCHIT) EMR products have not gained a foothold in the orange-shaded, high-performance area because even a small decrease in productivity for these highly productive specialists is too great. On the other hand, CCHIT EMRs have found some success among lower-volume, lower-revenue specialties, which fall in the unshaded area of the graph. A thorough reading of the CCHIT Certification Criteria reveals CCHIT’s primary-care focus.

Productivity-driven, high-performance practices demand EMR solutions that are productivity-focused. Hybrid EMRs are the only EMRs to enjoy a proven track record of success in this marketplace.

What Is a Hybrid EMR?

The continued success of hybrid EMR has prompted extensive debate about what actually constitutes one. While the Internet is now filled with discussions about EMRs, the number of conversations regarding hybrid EMRs has exploded. People are always asking me what it is that makes hybrid EMRs work so well and how they are different from traditional (CCHIT-type) EMRs. This is the first in a series of 3 discussions that will address this subject.

A hybrid EMR is a high-performance EMR that is successful in high-performance practices.

In 1997, SRS created the first hybrid EMR, concentrating on performance-driven practices, where high-volume physicians demanded unencumbered productivity. As others have followed our lead, hybrid EMRs continue to be designed with efficiency and speed in mind. This emphasis on performance criteria contrasts sharply with traditional EMRs. As a reading of the CCHIT criteria reveals, traditional EMRs are constructed for lower-volume, primary care practices where speed is not a primary driver.

SRS has built the largest national network of high-performance practices that successfully use an EMR. Our development process is driven by these practices and we work to facilitate the sharing of best practices among them.

In the next segment of the series, I will share my thoughts on a key defining characteristic of high-performance hybrid EMR—high usability.