In what appears to be an extension of yesterday’s post, today I want to examine some questions posed by Success EHS, which asks, “Should you replace your EHR?”
As you most likely know, most large enterprise ambulatory practices and hospital systems have well-established EHR systems in place. They are clearly recognized as among the early adopters of electronic health records, and, compared to their small counterparts, are also the most likely healthcare facilities to currently be in the market for an alternative EHR.
In the age of meaningful use, in a time where healthcare technology is also known as the electronic health record, the systems are being replaced with great frequency. The why and what fors are pretty simple to figure out if you’re familiar with the technology and the marketplace.
There are several prevailing reasons practices are jumping systems, though. They include (and I’m citing Success EHS here):
• Lack of strong vendor support
• Lagging product development
• Consolidation of disparate solutions
• Systems fail to live up to vendors claims
• EHR hinders efficiency and productivity
Given these hurdles – there may be others, of course – there are several questions practice administration must ask to determine whether it’s time to move.
Some of these questions include (feel free to grab a pen and paper and add to the list):
• Are issues able to be solved through remediation? No? Might be time to hit the road.
• Can the vendor’s technical improvements resolve any issues? If so, you need to ask that fixes be made in a reasonable timeframe. Obviously, telling said vendor that fixes need to be made “ASAP” won’t do; you must be reasonable. Consider negotiating a term of three to six months and get final terms in writing. Anything more than six months and it might be time to pack up and leave.
• Are you partially responsible for the EHR’s issues? If you’re partially or fully at fault for a botched EHR implementation or for poor usage, you owe it to yourself, your staff, your patients and, yes, to your vendor to work out a solution. If you’ve tried every solution and there’s no fix, you may be forced to move on. Some times it’s a matter of agreeing to disagree, let’s just agree on that.
• Do you have an opt-out clause? If so, you may wish to exercise it. If not, you’re going to pay, probably handsomely, to exit stage right.
• Are your current long-term goals going to be met using your current EHR? If not, you need to change your goals or change your system.
• Is your EHR negatively impacting practice efficiency? Success EMS says it best, “An EHR that hampers productivity now will only grow worse as the complexities of health reform initiatives increase in the future.”
If you decide it’s time to implement a new EHR system then it’s time to create an assessment plan. Assessments are designed to answer the “why” of implementing an EHR, and what is working and can be improved by installing one.
You can learn more about those here: Assess Your Practice’s EHR Readinesss and Plan Your Implementation.
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In taking a look around the HealthIT.gov site recently, I once again stumbled upon its series dedicated to offering practices insight into how to implement an EHR. A several part series, topics included cover what to look for when selecting a product, how to conduct training and, ultimately, how to reach meaningful use.
Given that nearly 50 percent of all practices currently have some sort of EHR, the process for setting up and implementing the systems are becoming more well known; however, having a clear plan and getting a little advice goes a long way.
So, without further ado, the following information is valuable and bears repeating, at least in part, even if you heard some of it before.
When starting an EHR implementation, a practice should assess its wants and needs. Keep in mind that no implementation is going to go completely smoothly (or at least as smoothly as imagined) so it helps to have a plan for what to expect and the plan should include room for error. Figure 10 to 15 percent in added time, resources and staff commitment over and above what you originally plan.
During the assessment, there will be some error and a few hurdles to jump. Don’t allow yourself to be told otherwise. If someone tries to tell you differently, that person does not have your best interest in mind.
If it’s a vendor, run. Do not purchase the product from the company because it’s only the beginning of what’s likely to be a long road of misinformation and false expectations. And no one appreciates being snowed, especially when you’re spending money on something.
Asking yourself questions
During the assessment phase, you also need to determine if you are even ready to implement a system, and if not, what more you need to accomplish. Assessments are designed to answer the “why” of implementing an EHR, and what is working and can be improved by installing one.
According to HealthIT.gov, “practice leadership and staff should consider the practice’s clinical goals, needs, financial and technical readiness as they transition.”
The site provides the following questions that practice leaders should consider during the process:
- Are administrative processes organized, efficient and well documented?
- Are clinical workflows efficient, clearly mapped out and understood by all staff?
- Are data collection and reporting processes well established and documented?
- Are staff members computer literate and comfortable with information technology?
- Does the practice have access to high-speed Internet connectivity?
- Does the practice have access to the financial capital required to purchase new or additional hardware?
- Are there clinical priorities or needs that should be addressed?
- Does the practice have specialty specific requirements?
What will the future look like?
Next up, it’s time to envision the future. Think about what you want to accomplish with an EHR, and write as part of your plan some things like: how are patients going to benefit, how can the care provided be better and how are providers’ lives going to change?
Finally, set some goals. According to HeathIT.gov, “goals and needs should be documented to help guide decision-making throughout the implementation process. And they may need to be re-assessed throughout the EHR implementation to ensure a smooth transition for the practice and all staff.”
Goals guide an EHR implementation, and are set once an assessment has been completed. As in life, goals provide an achievable end to an arduous task; the medal at the end of the race, if you will.
When developing goals for the implementation forgo conclusions like trying to determine what amount of savings will be created or how much of an increase in the number of patients or revenue will come into the practice. For now, these are intangible and often create a sense of failure if not immediately met after the EHR is “turned on.”
Keep the goals more process oriented and related to practice strategy and team building. For example, what goal do you have for the transition team? Do leaders emerge? Do advocates and coaches come to the forefront of the team that you had not expected? What practice visions are realized? Are you now more technologically savvy and able to attract better talent to the organization?
Perhaps you have business goals (other than the aforementioned money goals). Do you have a stronger business-planning process and clearer organization objectives now?
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If physicians use healthcare technology so much less than practice administrators and others in the average practice with these implemented systems, why do they continue to receive so much of the marketing and pre-sales attention from vendors and others in HIT community?
All healthcare vendors take a similar approach with physicians as they jostle for a lane at the front of the race. They gear their public-facing collateral and educational materials to physicians knowing all the while that they also must woo practice administrators and support staff. Rarely, though, is there any effort put into publicly promoting healthcare technology systems to non-physicians nor is there much effort behind celebrating non-physician care givers and administrators as the industry’s leading users of HIT.
It should come as no surprise that non-physician practice employees, such as RNs and PAs, use the systems like electronic health records, much more than their physician counterparts, on average. But, for whatever reason, HIT messaging is all about the physician and continues to be tailored to these mascots and figureheads within practices and healthcare settings.
EHR Watch’s editor, Jeff Rowe, recently published a blog post about the amount of time physicians use healthcare technology as opposed to their in-practice colleagues like RNs and PAs.
In his succinct summation PAs and RNs spend more time online for professional purposes than physicians; during consultations, PAs and RNs leverage mobile applications more at the point of care than physicians; and, in his words, “PAs and RNs use pharma or biotech websites more frequently than physicians and are more interested in using pharma features on electronic health record systems (EHRs).”
If physicians spend most of their time seeing patients and administering care, there’s nothing shocking about this data. It’s a good thing; they need to be seeing patients, not playing around on their computers.
However, this information should validate what everyone in healthcare already knows: Physicians are not the only ones using healthcare technology, and more can be done to include healthcare’s other care providers (and leaders) in the conversation about the technology and how it affects business and patient care outcomes.
The data Rowe provides also should encourage practices to continue including non-physician team members in the selection process of new technology if they are not already doing so because, clearly, though physicians are experts in providing care, they are not always the experts in using a practice’s technology solutions.
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Does healthcare technology actually interfere with patient care? Apparently so, according to a new study commissioned by athenahealth.
“Overburdened” physicians face pressures from continual government “intervention,” “increased use of and frustration with EHRs” and “administrative burdens.”
According to the study, physicians are disenfranchised.
Why? Well, according to athena’s study, there’s too much change. Perhaps that’s a bit of a blunt summation, but it seems to be the picture the study paints.
Nearly half the physicians interviewed for the study said electronic health records were not designed with the physician in mind while nearly two-thirds said the EHRs take away from their ability to engage with patients.
Some of this is obviously subjective opinion. Of course, there’s really no way to measure whether or not patients feel put off by their doctors entering data during the visit. On the contrary, there are plenty of reports to suggest that patients actually appreciate that doctors use an EHR during the visit.
However, from the eye of the beholder (physicians), they’re the ones sitting in the practice day after day getting a feel for the moods of their patients in the exam room once the keyboard comes out.
Sadly, the conclusion they have come to as a collective population is that EHRs are significantly reducing the quality of care patients receive. Again, this is filled with opinion, but if it’s the mood conveyed, that mood is bound to rub off on the patient population and will affect their perception of the technology, too.
These same physicians – more than 80 percent of physicians in the study – also feel the future of the independent practice is not viable, and more than two thirds feel the quality of care will greatly diminish over the next five years because of all these continuous distractions, including technology’s pervasiveness in the practice space.
This is stark “reality” for the profession from the mouths of its professionals.
Interestingly, in a completely unrelated study by recruiting firm Jackson Healthcare, more than a third of private practitioners say they will quit private practice within the next 10 years because of “declining reimbursement, capitation, and unprofitable practice; business complexities and hassles; overhead and cost of doing business too high.”
Where they’ll likely end up is obvious: in a hospital setting or in a hospital-owned practice. Why leave? They said they fear economic factors facing private practice (the first reason given) and they don’t want to practice in the age of reform (second response), which may be quite difficult given the current climate of healthcare.
What does all of this eye-opening information mean?
Well, it doesn’t bode well for those concerned about the ever increasing shortage of healthcare providers.
Perhaps more troublesome, though, is that no matter how much time is spent educating and informing certain segments of the healthcare population, there are always going to be many who remain unconvinced that technology produces practice efficiencies and helps lead to better care outcomes.
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Patient engagement will continue to become more popular as consumers take greater ownership of their care and begin to discover that their health information should actually be easier to access because of electronic health records and patient portals. However, patients must have reason to engage for this trend to become less of a trickle and more of a flood.
Healthcare technology is meant to allow more access to, and increase the availability of, patient’s health information. At least that’s one of the desired outcomes of the push (meaningful use and federal incentives) to lure physicians to adapt the systems.
Sterling Lanier, CEO of Tonic Health, succinctly sums up lack of patient engagement in a recent editorial published by For the Record magazine.
In it, he states that healthcare, like government, is filled with vernacular and jargon – HIEs, EHRs, ACOs, HIT, et al. – and the more these terms continue to be used, the less likely patient consumers are going to interact and engage with the healthcare community, and to take ownership of their own care outcomes.
As Lanier notes, and as I have often thought, to bring patients into the conversation, they have to be treated like consumers and they must have a reason to “buy” into the system. In this case, consumers must “buy” the information given to them. If they buy and own it, they’ll want more of it, or so goes the prevailing thought.
But simply speaking in terms the natives will understand isn’t enough. Consumers need to better understand how the technology they encounter at the doctor’s office helps produce better care outcomes. They may need some education and certainly they need some engagement once the systems are in place and being used during the visit.
Though patients will interact with the EHR less frequently than other technology they encounter, such as the patient portal (which they can actually use and interact with on their own), that doesn’t mean the EHR should be ignored during the interaction or treated as a foreign concept. In most cases, let’s remember, healthcare is actually behind many other consumer markets so consumers are actually more versed in the use and capabilities of similar systems outside their doctor’s office. Besides, we’re like children with devices and must test drive things like smart phones, televisions and computers as we learn to use them; we like to get our hands on the technology to try it out to satisfy our child-like need to see with our hands.
Even though patients can’t “touch” their EHRs, we can watch the information we provide our doctors being entered into the system; we can speak with our caregivers as they toggle and tab; and we can engage clinicians as they review our profiles and medical records. As a patient of a doctor with an EHR, I ask questions about the system: what it does, who makes it, why it was chosen and if it layout closely resembles the clinics’ past paper charts. I feel better about the little details and doing so makes me feel as though my doctor is listening to me during the visit.
Asking me these questions engages me more in my healthcare, and more than likely, engages my doctor in my care and outcomes.
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The Olympics always inspire me. They are one of most fantastic human events to witness, including the obvious sportsmanship; athletes overcoming obstacles; the sheer passion displayed by those competing in the field; the pain and joy of the athletes; shots of their family’s responses to the competition; and the personal stories and exposition about overcoming the odds.
Despite the haul of medals taken by the likes of swimmers Michael Phelps and Missy Franklin, the U.S. women’s gold in gymnastics and Serena Williams in tennis, other Olympic contributors will leave London without any hardware, but perhaps having just as much impact.
Healthcare technology continues to invade nearly every aspect of life, and the Olympics are not immune. One of the most notable appearances of HIT in the games has been by GE Healthcare. Actually, from my recollection, GE has been the only game in town during the greatest human competition on the planet.
What GE has done so well during the games is connect its products with consumers. Through a series of informative commercials, those of us on the sidelines have been able to learn how GE’s systems help keep the games clean, how they help identify and localize athletes’ injuries and potentially help treat injuries more quickly, and finally, how the systems actually help us in our lives anywhere we may be.
For example, we are also able to see how GE’s healthcare technology is being used to change lives, as is the case of its commercial about the technology serving an East London hospital’s pediatrics unit.
The stories featured in GE’s commercials are compelling for a couple of reasons, primarily because GE is the only technology vendor talking about how its products change the lives of real patients, but also because GE is taking the healthcare technology conversation to people who never would have otherwise engaged or thought about technology in healthcare without the commercials.
Consumers are not often engaged in conversations about the benefits of the machines and software they encounter during trips to the hospital or while meeting an iPad screen in their physician’s office.
Most patients have no idea what the letters “EHR” stand for. Those of us in healthcare technology seem to forget that; we pollute our own well, if you will. We get so enamored with the industry, its terms, its regulations and its advancements that we forget there is a whole world out there, that we eventually must try to sell to, that doesn’t know the first thing about technology or its purpose in healthcare.
Prior to my joining the EHR vendor space, I only knew things like, “That big tube thingy take pictures of my insides,” and “The jumping green line on the electronic graph means my heart works …”
But, those of us in the HIT community like to talk technology, and if we can’t find someone in the real world to listen, we talk to ourselves, which brings me back to GE.
If for no other reason than to educate consumers of the importance of healthcare technology and how it can impact something as mainstream as the Olympics, the company at least brought the conversation to the public and met consumers in their world rather than simply ignoring it like so many others, and that’s admirable.
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Another day, another EHR survey, and once again it’s about the security of information contained in electronic health records.
Apparently, according to this latest survey, more needs to be done to educate patient consumers of the value of the healthcare technology they encounter in their physician’s offices even though more than 50 percent of respondents said they feel EHRs are better than paper charts. Specifically, in this survey patients feel their personal information contained in the EHR is vulnerable to security breaches or hackers.
The data captured in this survey is not surprising, nor is it anything new. In fact, the following statement came from an April 2011 survey I administered for a major healthcare software vendor and announced to the press:
“While both physicians and patients believe that EHR will help improve the quality of healthcare, both groups have concerns about privacy and the security of EHR.” – April 26, 2011.
Though many people think the burden of educating the public about the benefit of EHRs should be placed on physicians, I disagree with this stance.
Physicians, frankly, are consumers of EHRs, just as patients are. It’s an unfair burden to put a group of consumers in the position of advocates for products they pay to use. In what other commercial industry do the manufacturers and retailers of products leave the education of the product to consumer? Correct me if I’m wrong, but I can’t think of any.
The burden of educating consumers about the value and importance of EHRs should fall to the EHR vendors. After all, the vendors are the experts of their products’ capabilities, not the physicians. Automatically electing physicians into this role is unfair.
When I represented an EHR vendor, we brought our message to physicians and patients. Get patients to realize the value of EHRs and you drive them to persuade their physicians to adopt the systems. Our stance meant we held ourselves responsible for educating the market about our EHRs’ capabilities. We didn’t feel that it was right to put our physician clients in the position of becoming product advocates unless they wanted to be. Advocating our products was our job.
As patients become more familiar with EHRs, they will fear them less, just as happened with online banking and shopping. Familiarity and comfort with these systems have changed and so have consumers’ perception of them; the same will ultimately happen for EHRs.
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According to the latest Centers for Disease Control and Preventions’ National Center for Health Statistics survey of 2011 EHR adoption trends, released on July 17, use of EHRs is up to 55 percent of practicing physicians. That’s a 5 percent increase from 2010, also according to a CDC survey.
The survey of 3,180 physicians was funded by the Health and Human Services Department’s Office of the National Coordinator for Health Information Technology. More than 55 percent of all physicians use and EHR (and more than 86 percent of physicians in practices with 11 or more physicians use an EHR). Physicians also value their current EHRs more compared to past iterations of the systems and, finally, respondents said the care they provide to patients is better than in the past because of the EHRs.
Problem: there’s no data in the survey to support this final claim.
Obviously, EHRs are intended to improve care, whether at the individual level or at the practice level. However, physicians accessing patient data through the records should be tracked and made quantifiable.
Practices using EHRs have the power to change lives for the better, manage care and ensure proper care is provided throughout a patient’s care plan. Practices can and should track how care initiatives have changed with the implementation of an electronic health record and how their patient populations’ health benefits.
Simply stating that patient care has improved when a practice uses an EHR is an immeasurable statement. Innovative practices find ways to track these outcomes whether it means there are fewer chronic conditions among their patients or that their patient populations’ life expectancy actually increased over a period of time (as can be measured and in some cases has been done).
The ONC needs to do more to encourage physicians to move beyond meaningful use stimulus, which is driving the increased use of EHRs. And while the data collected from surveys such as this are important, as I continue to say, they don’t tell the whole story of how technology can improve healthcare.
And throwaway statements indicating immeasurable “facts” does nothing more than generate misleading headlines.
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The numbers don’t lie. The meaningful use incentive program is working, at least as far as awarding stimulus funds is concerned. The incentive program awarded “761 hospitals and 56,585 professionals a total of approximately $2.3 billion for 2011; $1.3 billion to hospitals and $1 billion to eligible professionals,” according to Healthcare IT News.
The median payment to hospitals was $1.7 million. According to the same publication, in a recent interview with National Coordinator for Health Information Technology, Farzad Mostashari, his top concern is how hospitals and practices embrace the spirit of the rule and use their technology to successfully engage patients.
From dollars to sense. Without patient engagement, meaningful use is meaningless. Without applying the patient information to the population served and working to improve outcomes and offering education and guidance – perhaps creating support groups for smokers wanting to quit or practice-sponsored nutrition plans for obese and diabetic populations – to patients, meaningful use is nothing more than a government-run plan to collect information about its citizen’s health.
Incentives aside, healthcare providers should wish to do no harm and use the information available to fully commit to embracing change through the technology and data available and do what they do best: care for and help provide health education to their patients, their customers.
In other words, to borrow a line from Mostashari, “If you treat meaningful use as work, you won’t get much out of it.”
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We read the data and follow the numbers. Facts don’t lie. Technology can, and does, help improve health outcomes. People’s lives can be improved. Trends can be found and issues addressed.
It’s much less common, though, to hear about how these devices, this technology – electronic health records, for example – are used at the care level in the practice or at the hospital.
Not necessarily the “thought leaders” in the industry, doctors and administrators down the street use this technology to build more efficient business, grow practices and create jobs. The technology allows practices to accommodate the increased number of patients that can be seen each day because a practice management system helps streamline operations so succinctly.
In another world, in a land where the term “thought leaders” is not known, a physician toils her way through an impoverished, uninsured community providing education and ensuring her chronically ill patients are receiving the care they need when they need it, even if she’s conducting house calls and working seven days a week to meet the community’s need for healthcare. How she uses or doesn’t use her technology affects lives. How? You’ll find out soon.
Healthcare technology allows worlds to merge. Distances between providers and their patients are reduced to nothing more than access to a connected device and a Skype account.
But promises delivered are not always dividends gained. Along with the highs, there have been lows. The technology still is not perfect, but for all problems there are typically workarounds.
And while questions will always remain, and thought leaders, government officials and vendor leaders convene to help make things more meaningful, every day folks will continue to run every day practices in every day areas of the world, with or without the help of their technology and technology partners.
Their stories and more – views, observations and opinions — are here at Electronic Health Reporter: at the heart of healthcare, where you live.
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