EHR: Great Expectations?

It’s so interesting how the same statistics can be interpreted through different prisms to arrive at opposite conclusions. In a past post, I wrote about the recent comprehensive MGMA study that explored the EHR experiences reported by over 4,500 professionals, representing 120,000 providers, focusing on the effect of EHR implementation on providers’ operating costs and productivity.

In this month’s issue of MGMA Connexion, David Gans, MGMA vice president, discusses the results of this study. He points out that EHR benefits to providers increase as they increase training and optimize their EHRs—“optimize” being defined as allocating sufficient time for physicians and staff to become familiar with the system—not a surprising finding. The tone of the article leads the reader to view as good news the fact that 37.7% of the respondents who claimed that they had optimized their EHRs reported productivity gains.

This statistic lends itself to a glass-half-full versus glass-half-empty analysis. Shouldn’t we look at this result with considerable concern since it means that 63.3% of optimized EHR users are not experiencing improved productivity? As the shaded area of this chart illustrates, if we did nothing to change these results, the vast majority of EHR users would never realize productivity benefits.

This is not a condemnation of EHRs, but rather a caution that physicians must evaluate their EHR options carefully to ensure that they purchase a system that is designed for their particular specialty and workflow—one that they can implement easily and optimize quickly, and that delivers increased productivity from the outset.

MGMA Confirms Productivity Loss with Government’s EMR Program

What struck me at last week’s annual meeting of HIMSS (Health Information and Management Systems Society) was the conspicuous absence of conversation about the effect of the ARRA legislation on physician productivity—there was hardly a mention of the subject throughout the conference. Jeffrey Belden, M.D., of the HIMSS Usability Taskforce, did point out that documenting patient exams in an EMR takes 10 times as long as documenting by dictation, but offered no solution to that problem. Admittedly, the audience contained few, if any, physicians. However, once again, it struck me that physician productivity was the elephant in the room—the topic that no one was discussing, even though physicians are the very people upon whom the success of the program is so dependent.

I arrived home to the release of the results of a new MGMA study (conducted last month), which concluded that practices expect that the operational changes required to meet the proposed meaningful use criteria will cause a significant decrease in productivity. Nearly 68% of the respondents anticipate such a decrease, with 31% projecting that the decrease would exceed 10%—and this was likely based on only the impact of Stage 1 meaningful use criteria.

This productivity loss is what I described in last week’s EMR Straight Talk post, where ARRA meaningful use requirements compound the reduction in productivity that is already associated with the “point-and-click” EMRs themselves. Before ARRA, physicians estimated that traditional EMRs reduced their productivity by between 20% and 40%, as documented in testimonials posted on the Government’s FACA blog and included in the Voice of the Physician Petition. Others are speaking out about this issue as well; Paul Roemer reported that his cardiologist puts the productivity loss at 30%, due to the amount of time that he “wastes” performing clerical—i.e., data entry—tasks. (Read his comments in “Healthcare IT, How Good is Your Strategy: A Scathing Rebuke of EHR.”) Added together, this means that physicians face a 40% reduction in productivity at the outset. Imagine what will happen to productivity when the more stringent Stage 2 and 3 meaningful use criteria are implemented!

The conclusion is clear. Physicians should not be considering EHR adoption for the incentive money; they should be looking at what will help them address their business and patient-care needs. The HIMSS keynote address by chairman Barry Chaiken, M.D., charged the EMR industry with “creating healthcare IT solutions that are so compelling, so irresistible, that people just want to use them.” Systems like that already exist—they just don’t interest the government, which appears to be more interested in data collection than EHR adoption.