EHRs and Productivity Loss: How Can This Be Acceptable?

The purpose of automation is to increase efficiency and productivity. Every industry that has undergone the transformation from paper to digital has realized these benefits immediately . . . every industry, that is, except the EHR industry. Why is this acceptable?

Even the AMA acknowledges this failure—and yet seems to accept it. Toward the end of its newly released, and otherwise very helpful, video on how to select an EHR is the test question: “What is the ‘best practice’ in terms of the number of patient visits to schedule during the first week of operation with your new EHR?”

Why does the AMA think that the correct answer “A”?:  “Reduce the number of patient visits by up to 50% for the first week to allow you and your staff to learn how to use your new EHR.”

Why isn’t it “D”?:  “Your new EHR was carefully selected to fit into your practice smoothly and seamlessly. There should be no impact on patient volume that first week.”

Why does the typical EHR implementation follow the bottom line of the graph below, when it should look like the top one? Dr. Jacqueline Fincher’s testimony at last week’s HIT Policy Committee’s hearing on “Experience from the Field” is representative of the all-too-common experience.

Dr. Fincher reported an “absolute requirement to drop patient volume by half for the first three months [due to] an exponential learning curve,” and that she and her partners “have never gone back to the previous volume of patients,” even after 5 years of EHR use.

Some argue that the medical business is different from other industries like banking and shipping. That is very true. The type of data collected is different, and the level of employee responsible for inputting much of the data is also very different. In most industries, it is the lower-level, less costly employees (such as bank tellers and UPS truck drivers) who input data, while in medical practices, it’s actually the CEOs (i.e., the physicians) who do it. This makes productivity all the more critical for an EHR. According to the recent MGMA study on EHR adoption, fear of productivity loss is the primary barrier to EHR adoption—a concern justified by reports from experienced users, as illustrated below.

For the EHR industry to evolve as necessary for widespread adoption to become a reality, choice “A” must be rejected as totally unacceptable by physicians and the professional organizations that represent their interests. Physicians should expect more from their EHRs—they should demand that vendors deliver productivity, not merely fancy features and functionality. The truth is, they can get both, but only if they do their due diligence.

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.