Let’s move past today and imagine that it is January 2012. It is not beyond reason that a visit to a doctor’s office will be as streamlined as connecting through a portal on the Internet to schedule an appointment. Admissions happen via voice command and thumbprint technology. Diagnostics are ordered based on information during admissions. [...]
Let’s move past today and imagine that it is January 2012. It is not beyond reason that a visit to a doctor’s office will be as streamlined as connecting through a portal on the Internet to schedule an appointment. Admissions happen via voice command and thumbprint technology. Diagnostics are ordered based on information during admissions. Examination rooms equipped with personal computer stations or wireless tablet computers will enable the physician to view a patient’s medical record with the click of a mouse or an electronic pen. Lab results will be available immediately for viewing during the examination. Prescriptions can be entered via voice command and filled immediately by your pharmacy. Billings will happen automatically and electronically, and it is not out of the question that electronic payments to the practice’s bank account could happen within 48 hours of an office visit.
Although technological advancements should propel the healthcare industry into the streamlined, state-of-the-art process outlined above, in actuality, only a very small percentage of practitioners are effectively utilizing the available resources. The initial investment of dollars spent and time required to train and acclimate to a new system is a main deterrent. The overwhelming number of options further adds to the confusion of having to adopt to the way of the future.
Physician practices have been reluctant to spend appropriate dollars on technologies to improve operations. In today’s environment, physicians are being challenged to practice medicine and run a profitable business. Decreasing reimbursements and lower net profits have forced radical changes in practice management and have accelerated the adoption of technology beyond the basic billing office. Many companies have created technological solutions addressing various “pain points” within healthcare. These companies have focused on areas which they perceived to be inefficient and in need of automation. A staggering myriad of solutions is available to medical practices, making it necessary to wade through the options to find the best solution.
The challenge for now is to find a foundation of technology that will enable you, the physician or healthcare information manager, to build a complete solution in the future. The foundation must be based on a strong Practice Management System (PMS) and newer technologies that enable the practice to automate the clinical processing within the practice. Seeking product differentiation, leading PMS vendors are rolling out an ever-widening array of optional modules and are tailoring PMS to meet the rapidly changing needs of the practice management system market. Top EHR vendors are now adding PMS functionality for small, midsize, and large group medical practices and the fast-growing management services organization (MSO) and Independent Physician Associations (IPA) market. This trend will continue through 2015 as group practice consolidation accelerates and the average practice size continues to grow.
Healthcare in the United States is at the beginning of a technology revolution as previously paper based processes move online. The challenge for now is to find new delivery technologies that will enable the physician, hospital, or Integrated Delivery Network, to build a complete solution that enables the Digital Medical Office of the Future to become reality. The foundation is likely a clinical information management tool that serves as the connecting point or collection device for all of the technology deployed within the healthcare delivery marketplace. Today, we call this technology “Electronic Medical Records (EMR) and Electronic Health Records (EHR).” This repository of information will enable the care provider access to information that flows into, or out of, a community. Healthcare end users need to ask themselves whether all of this patient information could reside in one system.
The Answer is Yes
Eight years later, we have determined that the current ambulatory EHR marketplace needs a complete revamping if we are ever going to come close to the national goal of having over 80% of the physicians using an EHR by 2014.
Where do we start? Let’s start with the positive. The government has estimated that the nation could save over $200 billion annually if physicians adopted EHRs. Additionally, it is estimated that more than 90,000 lives could be saved. Software vendors have promised a 3% to 8% increase in provider revenues and improvements in efficiencies that can exceed 18%. The government has even jumped on the EHR band wagon by offering a program that certifies product functionally following standards by a federally funding program labeled CCHIT. With the average cost of EHRs finally starting to come down, you would think that there would be a rush of healthcare organizations embracing new EHR technologies. Even President Obama’s 2009 stimulus package includes over $18 billion in government incentives for technology adoption. Everything points to an explosion in the EHR marketplace.
Physicians have not leaped into the EHR jungle. In fact, according to numerous studies, EHR adoption has been minimal. Organizations estimate that US EHR adoption and full utilization barely exceeds 4% with an additional 13% of the physicians using parts, but not all, of the EHR applications. So with the perceived benefits of EHRs, why has the industry been slow to adopt? Ok, now we are going to talk about the negative side of the EHR marketplace. Let’s start by looking at a few of the problems.
The MYTH Busters
· Saves Time. Every vendor will tell you that their EHR will save you time. However, when you ask for specifics you usually receive some vague reference to a study completed years ago by someone else. The better question should be, “Prove to me that the vendor’s specific EHR will save me more time than any other EHR product.” Where is the proof? Where is the third party study that validates the perceived time savings?
In a paper based system, the average physician spends less than 120 seconds recording clinical information about a new patient and only 38 seconds recording information relating to clinical indicators during a return or established patient visit. When evaluating the amount of time that is typically required to conduct a visit using an EHR, we found that the average provider spends 7.5 minutes on new patients and 4.3 minutes on return patient visits. Given the average ratio of 13% new patients to 87% returning patients, the typical EHR would require an additional 187 minutes per day of charting time. That’s 3 hours of additional work per day. So where is the perceived time savings? To help solve this issue practices need to search for Discreet Recordable Transcription (DRT) enabled EHR products.
· Interoperability. Healthcare information technology (HIT) is grossly fragmented and has abysmal data sharing. It is fragmented and operates as millions of solo disconnected enterprises with little communication. To help solve this issue, practices and communities should look for products that are proven to be able to connect with an Integrated Community/Collaborative EHR. To help understand this we have created a new term called “Welcome to the ICE Age.”
· HIT Approaches to Date are Divisive and Compart-mentalized. Integration of our current healthcare delivery system into one seamless system is not happening. The healthcare industry must rethink its fundamental approach to IT automation and look at other industries who have successfully implemented interoperable IT frameworks such as Finance and Telecommunications. The use of a system that integrates EHRs can help solve this issue as long as we can create a separate database for each practice while allowing individual physicians to continue practicing medicine following best practices.
· Lack of User Interface Consistency. Doctors, nurses, and techs all must use different, often multiple interfaces to access information. They don’t want to learn “computering,” they want to provide care. There is no single access priority. Thus, clinical user adoption/utilization of HIT, despite acknowledged advantages, has been like “pushing mules.” Practices should be looking for one fully integrated PM and EHR product that has a close interface with a community PHR.
· Ancillary Medical Services, Police, Fire, Emergency Squads, etc., are typically neglected in current systems. Once again, the ICE Age will help solve this issue since first responders could achieve access to clinical data on patients following the national CCD standard for data sharing.
· Hundreds of Billions of Dollars are wasted every year in the US due to this gross lack of interoperability coupled with the resulting gross lack of coordination of information. With silos of information, the patient must provide the same data to multiple healthcare providers. The cost to capture and record a patient’s social history, medical history, family history, ROS, HPI, Vitals, Medications, lab results, etc. requires duplication of effort and the possibility of errors. The ability to share validated clinical data between care providers can help reduce data entry time by 67% while reducing the chance of errors by 92%.
· Millions of Lives are Needlessly Lost every year due to medical errors that result from poor data control and sharing. The problem is not with the providers, but with a lack of timely and accurate information that providers have when making clinical decisions. In over 83% of office visits, critical information is not available to the provider at the time of care. Many times, additional information is stored on paper in another practice’s chart room. In other cases, the patient cannot remember what medications they are taking or they tell the provider they are taking a different medication than what was originally prescribed by another provider. To reduce errors, we need all clinical information available to all care providers at the time of treatment and we must eliminate the silos of information that is stored in every practices chart room.
· President Obama’s Call to Arms to make electronic health records available to most Americans by 2014 will fail without major change. The current proposed stimulus package of over $18 billion will not solve any problems until the community of physicians stands up and makes it very clear that the current process does not work. Let’s face it, after 20 years we only have 4% of physicians fully utilizing an EHR. Someone needs to stand back and yell out loud once again, “I am Mad as Hell and I am not going to take it anymore.” The current process does not work. We need a new vision and we believe that DRT enabled EHRs and being prepared for the ICE age is that vision.
· Patients and Employers Pay the Price with needless loss of life and skyrocketing healthcare costs. The CEO of General Motors appropriately put this dilemma into context: “GM spends more on healthcare than it does on steel to build its cars.” Our proposed vision of DRT enabled EHRs and the establishment of Integrated Community EHRs (ICE) can help reduce overall healthcare costs by up to 23%.
· Current EHR Products Are Too Complicated. We need to learn to walk before we run. The designers of EHRs create systems to capture over 1,000 discrete data elements for each visit. The problem is that the data collection system requires, on average, seven times more input time than under the old handwriting or dictation process.
So where do we go from here? We will continue the process by drilling down deeper into a number of the factors including workflow and then new data entry methodologies. Once we have evaluated these areas, we will spend some time talking about the different types of clinical charting products and the five levels of EHR products that we have been able to identify based on our 4,000 question survey on product functionality.
Mark R. Anderson, FHIMSS, CPHIMS
CEO, Doctor’s Diagnostic Hospital
CEO and Healthcare IT Futurist, AC Group, Inc.
281-413-5572 • firstname.lastname@example.org
Mr. Anderson will be presenting at the HBMA Fall Conference in St. Louis, MO, on September 13 & 14, 2010.