Physicians Spooked by Failure Stories—EHR Adoption Suffers

May 10th, 2013

A significant portion of the physician market has still not adopted an EHR, despite the lure of government incentives and the fear of the penalties looming on the horizon [...]

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Senators Say Meaningful Use Program Needs Rebooting

April 19th, 2013

Yesterday, six senators released a white paper, Reboot: Re-examining the Strategies Needed to Successfully Adopt Health IT, that argues that there is no evidence [...]

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Beyond Meaningful Use Lies a Game Changer for Specialists

April 4th, 2013

I have frequently said that meaningful use is a primary-care program, and I still maintain that it was designed with primary-care physicians and their patients in mind. But I believe that specialists will be the greatest beneficiaries of Stage 2’s [...]

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Make It Happen!

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June 30th, 2009

The message is clear—physicians are concerned that their interests are being ignored, and they want their voices heard.

SRS is making that happen. We hear the voice of the physician and we will be broadcasting it to President Obama, HHS Secretary Kathleen Sebelius, Dr. David Blumenthal, the HIT Policy Committee, the HIT Standards Committee, and leading industry blogs.

Following last week’s post, entitled “The Silent Majority is Being Heard – Let’s Be Louder,” we invited SRS clients and non-clients alike to let us represent their voices in Washington. The response from physicians and practice administrators has been tremendous—not only have we already received an unprecedented number of signatures to our letter to government officials, but we are being deluged with individual comments to be forwarded along with the letter…and they are still pouring in.

There is still time to join the campaign:

  • Sign our letter and/or add your own comments.
    Click below to read and then sign:

SRS Client Petition Non-Client Petition

  • Share this with your colleagues—physicians and practice administrators—and encourage them to let us speak for them.

Whether your practice is using SRS, has another EMR, or is still on paper charts, this is about you. Will you be able to meet the increasingly stringent “meaningful use” requirements currently under consideration by the government? The following are just a few of the voices that your peers have already asked us to share with Washington:

  • “We support efforts to reduce the cost of healthcare without reducing quality, and we recognize the value of a computer-based health record for quickly sharing patient information with other providers and avoiding duplication of services. However, the methodology for doing so should not be so burdensome as to change how a physician practices medicine, particularly if it interferes with patient-doctor interaction.”
  • “We have implemented an EMR system in our practice and are leaders in our area in implementation of new technology. However, despite numerous attempts, we have failed to find an EHR system for entering clinic notes and orders that improves efficiency. Instead we have found it only makes us more inefficient, less productive, and more frustrated. The right technology is not here yet. We cannot be forced to implement a flawed system.”
  • “I am a primary care doctor. Point-and-click does not work for us either. The vast array of problems that we handle requires a more flexible way to document a visit. We handle usually 3 different issues on average per visit. Point-and-click falls apart if there is more than one chief complaint or if the patient tells us something that has not been considered by the point-and-click software. The documentation is forced to become less accurate. There is also an impact on the relationship with the patient since the doctor spends more eye contact with computer rather than the patient. I am not a doctor who is afraid of technology. I have a degree from M.I.T. in electrical engineering and worked as an engineer for years before changing careers. If point-and-click EMRs were useful, my practice would have had it years ago. Electronic prescribing has benefits and we have been doing that for years. We have a hybrid system that we currently use and will add other features when it makes sense. I do not believe we will ever use a point-and-click system even with incentives.”

The AMA is expressing the same concerns that we have been voicing—they formally came out against the planned penalties in the federal stimulus plan at their annual meeting this month.

Please add your own voice now, and let us make sure that you are heard.

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The Silent Majority Is Being Heard – Let’s Be Louder

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June 24th, 2009

The tide appears to be changing as the voices of the silent majority are finally being recognized in Washington. I have been repeatedly and emphatically expressing my concern that the needs of physicians—particularly high-performance physicians—are being ignored as the government attempts to encourage EHR adoption.

  • Last week, Gayle Harrell, an HIT Policy Committee member, made many of the same points that I have been making, as the Committee reviewed the initial set of recommendations on “Meaningful Use” and considered EHR certification. (Read the highlights in the post below, Finally, A Voice of Reason!)
  • In recent months, many of you have been speaking out on Straight Talk and other blogs. To the question asked in last week’s poll—is the government putting too much of a burden on physicians?—a resounding 90% of respondents answered “Yes.”
  • Physicians are voting with their pocketbooks, continuing to base their EMR purchase decisions on the best way to help their practices deliver the highest quality care in the most efficient manner, rather than on the promise of potential government incentives.
  • Even CCHIT (Commission for Certification of Healthcare Information Technology) has acknowledged these and other voices of reason. Just recently, CCHIT backed down on its all-or-nothing stance and proposed broadening its certification program to include alternative paths to EMR certification.

Comments like those of Dr. Boss (below) attest to the value of alternative, innovative solutions, such as the hybrid EMR, and to the importance of including them in the government’s plans for widespread EHR adoption:

“The best EHR system out there without a shadow of a doubt is SRS, even though it is not yet CCHIT certified. It is cost effective, user friendly to those of us who are not computer ‘geeks,’ and the company is extremely responsive to any needs of ours that arise. If the entire country was on SRS, a lot of our current difficulties would go away.”

Richard S. Boss, M.D.
Pine Medical Group, Fremont, MI
20-Physician Multi-Specialty Group

We will be sending you an e-mail tomorrow, giving you the opportunity to join us and have your voice heard before the final decisions are made in Washington.

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Finally, a Voice of Reason!

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June 17th, 2009

The HIT Policy Committee held its second meeting yesterday. Concern over how the specifics of the EHR incentives program will be worked out is apparently so high that public access to the meeting had to be cut off when the audience reached the online meeting software’s limit.

The “Meaningful Use” Workgroup had clearly done a lot of good work and devoted a great deal of time to the effort. They presented a detailed matrix which mapped out a phased set of objectives and measures, establishing end point objectives for 2015 and working backwards to the interim stage at 2013 and to an initial proposal for 2011. The set of goals begs the question, “Can it be done?” I want to share with you the comments of one lone Committee member who echoed the concerns that I have been raising in past posts on Straight Talk, in the media, and in conversations with physicians and administrators. Gayle Harrell, a former Florida legislator, was the only Committee member who seemed to be concerned about the impact on the physicians. The following is a sampling of the insightful questions she posed and the comments she made:

  • “Meaningful use” must be defined for specialists, not just primary care physicians. (The response from another committee member was more interesting than the comment itself—that it is not the best use of funds at this time to focus on specialists. That should wait.)
  • Beware of placing too many demands on physicians for data collection.
  • Recognize the excessive amount of training that is required to successfully adopt an EMR.
  • Be prepared for a 33% decrease in productivity for a period of time.
  • Are we setting ourselves up for failure?
  • Are we putting so great a burden on providers that they won’t use the EMR?
  • Is what we are asking physicians to do even achievable?

Ms. Harrell then posed the following thought-provoking questions to the Certification and Adoption Workgroup:

  • Has a separate EMR certification set been considered for specialists?
  • Who will be certifying the certifying bodies to make sure that the standards they set are actually relevant to “meaningful use?”
  • Has the Committee addressed how to overcome adoption issues?
  • How do we handle certification for innovative (non-CCHIT) companies to make sure we do not erect barriers and limit the market to the big EMR companies?

I hope that the members of the Policy Committee will address these legitimate concerns as they move forward in their efforts to define “meaningful use” to ensure that the goals are realistic and achievable.

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Risky Business

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June 10th, 2009

Watching the stock market’s gyrations over the past few months has made me reconsider investment strategies. I thought about the thousands of people who have won the million dollar lottery. These people have made a lot of money and swear by the lottery because it has changed their lives, and they would recommend lottery tickets as a great investment. Yet, I know for myself and for most people, we would not spend a significant portion of our assets on lottery tickets because we assess the risk and conclude that the likelihood of success makes betting the nest egg on the lottery an unsound investment.

So, little surprise, my thoughts turned to EMR and, specifically, the realization that in evaluating EMRs, the issue of risk is too often overlooked. EMRs are purchased after speaking to a few of the vendor’s success stories (i.e., lottery winners), which blinds the buyer from assessing the true, underlying risk.

When calculating expected return on any investment, one needs to account for the likelihood of achieving that return. Everyone who purchases an EMR enters into the process with the expectation that they will be successful. Unfortunately, history has shown that this is not the reality; the chances of failure with a traditional, point-and-click EMR are relatively high. Depending on the physician’s specialty, traditional EMRs carry a 50%-90% failure rate which explains why, according to a New England Journal of Medicine study, only 4% of physicians are using a fully functional EMR.

My business school Finance professor would insist that the expected financial returns resulting from any investment must be decreased by the chance of failure. So, for example, if you are a physician who expects $44,000 in EMR incentives from the government, you must decrease that expected windfall by at least 50%, to $22,000. Furthermore, you may be successful in implementing an EMR, but not in convincing CMS that you are using the EMR in a meaningful way, so you must adjust the $22,000 further downward to reflect this additional reality.

Unfortunately, when purchasing an EMR, payments to the vendor are not tied to the success of the product, so physicians must pay full freight and then hope that the ROI materializes—a lot like buying a lottery ticket. Don’t buy a dream! Consider all of the potential returns, realistically assess the likelihood that your physicians will actually use the EMR successfully, and adjust your expected ROI accordingly. You can make a sound business decision only by including “risk” in your analysis.

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From EMR Vendors: Fact or Fiction?

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June 3rd, 2009

The Economic Stimulus legislation has presented an incredible opportunity for EMR vendors. Unfortunately, it seems that some of them are taking advantage of it by giving out misleading information and applying scare tactics so that practices will purchase their EMRs. Below is a sampling of such statements, which have been forwarded to me by physicians asking whether they are “fact or fiction.”

Have you had similar experiences? Please share them by submitting a comment at the bottom of this post.

What some EMR reps are saying:

  • “The government is requiring you to buy an EMR.” This one is a scare tactic since participation is voluntary.Section 3006 of the American Recovery and Reinvestment Act specifically states “…nothing in such Act or in the amendments made by such Act shall be construed to require a private entity to adopt or comply with a standard or implementation specification adopted under section 3004.”
  • “Your EMR must be CCHIT-certified to qualify for the incentive payments.” I hate to use the word “lying” but this statement comes close since the legislation neither identifies standards nor mentions any particular credentialing body, including CCHIT. The HIT Standards Committees, which just had its first meeting on May 15, is charged with recommending an initial set of certification standards by December 31, 2009. Recently, there has been a surge of rhetoric in the media expressing dissatisfaction with CCHIT, so it is by no means a foregone conclusion that CCHIT certification will be required.
  • “Simply buy a CCHIT-certified product, and you will qualify for the Stimulus money.” This remark is similar to “I have a great stock to sell you”—because EHR incentive payments are not guaranteed. Simply purchasing a “certified” EHR is not sufficient; the incentives require you to demonstrate “meaningful use” of the EHR every year, and to do so in the manner specified by and to the satisfaction of the government. “Meaningful use” has not yet been fully defined, and the legislation states that the requirements are to become more stringent over the period covered by the law.
  • “You must act now—buy an EHR now because in order to get the money from the government, you must be using the EMR by 2011.” As with used-car salesmen, “buy now” is always popular, but you actually have until 2013 to implement and potentially qualify for the lion’s share of the incentives. Even if you do not implement until 2014 (5 years from now), you would still be eligible for almost 80% of the money.

Have you heard any of these statements of “fact”? My advice: Do your due-diligence. Make sure you understand the real facts about the legislation and find an EMR that meets the needs of your practice. Have you heard other statements of “fiction?”—Please share them by submitting a comment at the bottom of this post.

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Putting the Cart before the Horse

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May 27th, 2009

The vice-chair of the HIT Standards Committee, John Halamka, MD, opened the first Standards Committee meeting by charging the committee with “recommending standards, implementation specifications, and certification…in support of meaningful use.” But “meaningful use” has not yet been defined, which begs the question—Are we putting the cart before the horse?

In fairness, the Standards Committee, as well as the other planners and implementers of the EHR provisions, are under significant time pressure to meet the ambitious deadlines contained in the Economic Stimulus legislation. The initial set of standards for EHR certification is due by December 31, yet “meaningful use” has yet to be clarified—David Blumenthal “hopes to provide a direction and some specifications in the late spring, early summer.” Therefore, in the interest of time, all parties are discussing “meaningful use” and standards concurrently.

To compound matters, it appears that the certification/standards decision has essentially been made already—underlying the conversations is the ubiquitous assumption that CCHIT will be the government’s standards for EMR qualification. Perhaps this is driven by the need for expediency in the face of the looming deadlines, or perhaps it stems from the recommendation made by HIMSS. (See last week’s blog below.) In either case, how can we already know what standards are necessary to ensure meaningful use before we have a clear and complete definition of “meaningful use”? How do we make certain that the standards are applicable to all physicians, including high-performance, private-practice specialists, when CCHIT standards are primary-care focused? Do we need another set of standards for specialty practices? In any case, isn’t this a classic example of putting the cart before the horse?

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The Machinery Behind Health-Care Reform

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May 19th, 2009

This weekend, The Washington Post published an investigative report entitled “The Machinery Behind Health-Care Reform: How an Industry Lobby Scored a Swift, Unexpected Victory by Channeling Billions to Electronic Records.” The reporter, Robert O’Harrow Jr., clearly hit a nerve when he exposed the origins of the EHR funding portion of the Economic Stimulus Bill—The Washington Post received so many comments that it had to stop accepting responses! I am sharing my comments here, along with the original article.

Dear Mr. O’Harrow:

Thank you for exposing the behind-the-scenes efforts that led to the creation and funding of the Economic Stimulus Plan’s EHR incentives program. Industry insiders have long-recognized these inherent conflicts of interest, but have been reluctant to make them public.

It is important to understand that the situation is being perpetuated—the people now charged with developing the specific regulations regarding how the money is to be dispersed and the standards which will determine to whom it will be given are the very same stakeholders who were behind the legislation. One has only to listen to the recent “meaningful use” hearing in Washington and look at the appointments to the HIT Policy and Standards Committees for evidence.

First, to clarify your premise—it is not the entire industry that lobbied. It is the traditional EMR vendors who are positioning themselves to receive the benefits. Only the big, CCHIT companies have been invited to the table to be part of the conversation in any significant way other than through very limited opportunities for public comment. No vendors of alternative technologies, i.e., non-CCHIT-certified products, have been given any formal role, regardless of their successful adoption rates and greater physician satisfaction.

It is no wonder that CCHIT is the presumed set of standards which will be used to qualify EMR software for Stimulus Plan payments. The legislation was rushed through with such a short timetable for implementation that it is hard to dispute the conclusion that there is no time to develop new standards. The HIT Policy and Standards Committees are predisposed to CCHIT—the vendor community representatives on each committee are from large, CCHIT companies, and at least one committee member is a CCHIT commissioner. It does not seem to be of concern that these EMRs are the very ones that have experienced miserable adoption track records, (see Landmark EMR Studies), particularly among specialists, nor that evidence does not exist to show that CCHIT certification has improved this adoption record.

In an effort to push the implementation along, the interests of high-performance, private-practice physicians are not represented in the process. There are no full-time, private-practicing physicians on the Standards Committee, who can appreciate first-hand the impact the wrong EMR can have on a provider. The seven physician members spend most, if not all, of their time in informatics-focused positions at their respective institutions. Furthermore, the needs of non-primary care physicians are being ignored. By virtue of its composition, the Committee will focus on primary care—of the physicians on the Committee, five are internal medicine-certified, one is a pathologist, and the vendor representative trained as a neurologist. For primary care physicians, CCHIT-type software may be more usable than it is for specialists.

In the era of transparency, it is important that all of these issues be understood and then addressed before the enormous sums of money are dispersed with limited potential to achieve the desired outcomes.

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