EMR Reform: A Plan to Spur Adoption

A free market is the most powerful economic force on earth. According to Adam Smith’s The Wealth of Nations, this is because free markets let people make informed purchase decisions based on how products further their own interests. If left to operate without interference, a truly free market rewards products that consumers deem superior, and puts companies with inferior products out of business.

However, informed purchase decisions can be made only when unbiased information is available. Currently, in the EMR market, such information about the myriad of product offerings is largely absent, and purchasers must rely on unauthenticated vendor claims. It’s no wonder that physicians are reluctant to purchase these expensive systems—the risk of a financial disaster looms over their heads.

The barriers to EMR adoption are not problems that government incentives can even begin to remedy. What is needed to truly drive adoption is major healthcare IT reform. Transparency and full disclosure must be introduced in order for market forces to work and for widespread adoption to occur. Just imagine the effect of the following EMR reform proposal:

1. Increase the EMR success rate (and reduce the lamentable failure rate) by increasing product quality and usability through competitive benchmarking.

Physicians should have access to “click” comparisons that measure the efficiency of each EMR in conducting common office workflows—finding a chart, reviewing chart information, sending a message, creating a problem list, creating a prescription, signing off on a lab, or ordering a test. These comparisons would create a race to efficiency as vendors are forced to think about physicians’ workflow and productivity, and would ultimately create more usable, superior products. After all, which vendor would want to be known as the most point-and-click-heavy vendor in the marketplace?

2. Provide transparency by issuing audited vendor report cards.

A report card would measure each vendor’s previous three years of sales and their success/de-install rate by specialty. In the auto industry, the information available through crash-test results and the J.D. Power and Associates consumer-satisfaction reports give manufacturers the motivation to build cars that meet consumers’ needs and preferences. EMR purchasers should have similar quality data enabling them to make successful choices as well. KLAS has laid the important groundwork with their customer-survey-based comparative EMR data, but additional data from objective tests and non-vendor-selected customers would round out the picture.

3. Take the systemic risk out of purchasing an EMR by allowing providers to return EMR licenses if they do not perform as promised—in other words, an EMR Lemon Law.

A return policy would profoundly and positively impact adoption rates since physicians would be less likely to fear being victimized by false sales pitches, and vendors would be more likely to ensure that implementations went smoothly. It would also ensure that products not appropriate for a particular specialty would not be sold to those physicians.

These simple healthcare IT reforms will level the playing field and restore the sorely needed balance between vendors and physicians. The result will be faster, more confident purchase decisions and increased long-term adoption.

As Promised, Your Voice Was Heard

At Friday’s HIT Policy Committee meeting, SRSsoft Vice President of Government Affairs, Lynn Scheps, presented the Voice of the Physician petition to David Blumenthal, M.D., National Coordinator for Health Information Technology, and to each member of the committee (see pictures below). Lynn went to Washington, D.C., to make sure that the decision-makers heard your voice loudly and clearly—she urged them to read the petition and to heed the comments submitted by SRS clients and the comments written by non-SRS users. Taking the microphone, Lynn addressed the group with the following statement:

Presentation of the Voice of the Physician to the HIT Policy Committee
August 14, 2009

I have attended your past meetings via webcast, but I felt it was important to be here today to personally deliver this book, which you received this morning. The Voice of the Physician is a petition asking you to listen to private-practice physicians, on whose participation the success of the program depends. These are the physicians who will have to “achieve” what their EHR only has to be “capable of achieving.” They implore you to consider the daily realities of medical practice as you move forward.

The fact that a relatively small company like ours would receive such a response in just a few weeks, with minimal outreach efforts, is an indication of the deep level of concern pervading the physician community. Two things are clear: Physicians feel that their voice is not being heard and they perceive the government’s expectations as overly burdensome from a practical perspective.

The signers of this petition are not all SRS clients. Other providers reached out to us and asked that we stand up for them as well. SRS users or not, they are passionate about EHRs, and they speak from positive and negative experience with a variety of EHR products. Three fundamental themes dominated:

  • Physicians will not adopt technology that compromises their productivity,
  • They will not become data entry clerks, and
  • They will not jeopardize the physician-patient relationship.

No financial incentives or penalties will persuade these physicians to take actions they deem detrimental, or not valuable, to their practices.

One hundred and fifty of the signers of the petition are so concerned that they took the time to compose their own supplemental comments for you to consider. I hope that you will take the time to read through even a portion of them—their tone, intensity, and content provide valuable insight into what will be necessary to successfully encourage widespread EHR adoption.

Lynn Scheps, VP Government Affairs, SRS

SRS Vice President of Government Affairs, Lynn Scheps, distributes petition

Petition Distribution

The petition alongside the meeting agenda

Point-and-Click EMR: See What Can Happen

Rather than post a narrative commentary this week, I thought we could all use some levity! Every time I see this clip from “I Love Lucy,” it evokes an image of how a physician must feel when he uses a click-heavy EMR and struggles to keep up with his waiting room full of patients. See if you agree.
I Love Lucy – The Candy Wrapping Job

If this video is not viewing properly, please click here.

Make It Happen!

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.

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

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.

From EMR Vendors: Fact or Fiction?

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.

The Risk of Automated EMR Coding

A frequent topic of conversation is how to improve the claims-coding process. If you are intrigued by the automated E&M coding offered by an EMR, I suggest caution. This feature has high marketing appeal—promising that office visits will be coded to the highest level of reimbursement possible. Unfortunately, however, EMR coding has led to severe financial and legal repercussions for practices, as reported in a recent study in the venerable Medical Economics journal.

An increase in average coding levels raises a red flag with payers, and EMR documentation does not stand up well in the resulting audits. According to the authors, who assisted several practices during Medicare audits, the danger is that EMRs automatically guide physicians to create records that document high levels of care, and the result can be a statistically significant (and noticeable) increase in the percentage of claims with level-4 and level-5 codes. The templated chart notes created by traditional (CCHIT-type) EMRs all tend to look the same and do not contain the information necessary to justify these higher levels of coding.

In a claims audit, typically between 20 and 100 charts per physician are reviewed, and the results are then extrapolated to the entire set of claims for that payer. For the practices discussed in this article, between 20% and 95% of the EMR-generated claims failed the audit, and the physicians were assessed penalties and subject to repayments to Medicare that ranged from $50,000 to $175,000 each.