Another day, another study, but this one – about the EHR user’s satisfaction levels with their systems – seems to have some teeth. According to the survey, “EHR Satisfaction Diminishing,” which was administered by the adept AmericanEHR group, users of EHRs are becoming ever more disenfranchised with their EHRS.
According to the AmericanEHR, data was collected over a two-year period of time, from 2010 through 2012. After two years of use, and in some cases longer, practice leaders and caregivers who have time to figure out their electronic collection systems and who are past the test-drive phase say they are not happy with the technology.
I’ve made this case before, but this is one of the primary reasons I strongly recommend physicians not getting locked into extremely long-term contracts. For example, some vendors require seven years. That’s way too long. Stay away.
Nevertheless, this could just be a standard response to the technology as a whole, but let’s get to the results of the survey. For brevity’s sake, I’ve cut what I don’t find to be significant. Some of the results noted here are amazing and eye opening; you decide.
Highlights include:
71 percent of respondents were in practices of 10 physicians or less;
The average length of time that survey respondents had been using their EHRs was more than three years at the time of the EHR satisfaction survey;
Satisfaction and usability ratings are dropping. This holds true regardless of practice size, specialty type and across multiple vendors;
Overall, EHR user satisfaction reveals a 12 percent drop in satisfied users from 2010 to 2012 and a corresponding increase in very dissatisfied users of 10 percent for the same period;
In 2012, 39 percent of clinicians would not recommend their EHR to a colleague (I’m not surprised by this, especially given my experience with vendors);
Average satisfaction level with the ability to improve patient care decreased from 2010 through 2012 for all specialty groups;
Satisfaction with ease of use dropped 13 percent between 2010 and 2012 and 37 percent reported increased dissatisfaction in 2012;
34 percent of users in 2012 were very dissatisfied with the ability to decrease workload compared to 19 percent in 2010.
Why is this happening (according to AmericanEHR)? The following hypotheses may explain some of these findings:
With Meaningful Use, users may have lost some of their workarounds or have new ones that they have to do e.g. clinical visit summary that now takes 10 clicks and as a result workflow may feel more cumbersome;
The difference between cognitive versus procedural specialists. If one asked the majority of physicians how they would rate the quality of care they provide, most would likely say very good to excellent. Unless these physicians regularly use dashboards and reports they do not know whether they are doing better using an EHR. This is more challenging with procedural specialists such as a thoracic surgeon or orthopedic surgeon. It is not clear how the EHR helps with improving quality of care for proceduralists;
As we have further analyzed the data in related to satisfaction with the ability to improve patient care by duration of EHR use prior to completing the EHR satisfaction survey, there appears to be a strong correlation between length of use an EHR and ability to improve patient care especially in those who have been using an EHR for 5+ years. This could suggest that there is a minimum period of time that someone has to use an EHR before beginning to demonstrate improvements in patient care;
Dissatisfaction may also be a result of being asked to do something with an EHR that previously was not required (prior to Meaningful Use);
There continues to be an inability to complete certain tasks electronically despite having an EHR. For example, ACOs that require a paper form to be completed for registration of each patient in a pay-for-performance program, resulting in increased workload and decreased productivity/satisfaction.
Additional observations (which are amazingly insightful):
The speed of change in relation to the Meaningful Use program may be too much too fast for many practices who are unable to cope the demands and workload;
Different populations have different expectations. The pioneers and early adopters have a greater tolerance for the problems and challenges of implementing an EHR vs. those in the mid or late majority;
EHR systems clearly have usability issues which need to be addressed even with respect to basic functionality.
Recommendations (here’s the real gold):
Training is a significant deficiency. Training is required at all stages of adoption, both at time of implementation and as more advanced functionalities are required or integrated with EHRs. Almost 50 percent of respondents in a 2011 AmericanEHR report on the correlation of training duration with EHR usability and satisfaction reported receiving less than three days of training to use their EHRs or no training at all;
Dissatisfaction levels with basic EHR functionalities highlight the need to improve existing technologies rather than just focus on adding new features and capabilities;
Clinician workload within the practice must be re-balanced. Providers are working harder and face numerous additional challenges including the impact of payment reform and the need to comply with multiple incentive/penalty programs.
In closing, according to AmericanEHR: “If these issues are not recognized and addressed, the alternative is that clinicians will do the bare minimum in order to meet meaningful use requirements.”
A straightforward piece of news from TEKsystems Healthcare Services, a provider of workforce planning, human capital management and IT services to the healthcare industry, showing the following results a joint survey with HIMSS Analytics regarding health organizations’ readiness pertaining to the implementation of electronic health record (EHR) systems.
According to TEKsystems, the survey shows insights into the status of EHR implementations, the challenges healthcare organizations face and areas of improvement; TEKsystems and HIMSS Analytics surveyed 300 single and multi-hospital organizations and health professionals throughout the United States. Key findings include:
Current State of EHR Implementations
Nearly 39 percent of hospitals have surpassed Stage 4 of the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM).
Currently less than half (43 percent) of integrated delivery systems or single hospital systems have completed their EHR implementation.
Achieving end user adoption
Nearly two-thirds of healthcare professionals (64 percent) believe achieving adoption is a roadblock to a successful EHR implementation.
“Achieving meaningful use and truly improving the quality of patient care can only happen if end users fully adopt a new EHR system in an acceptable timeframe. Organizations expect their people to adapt quickly, yet many do not plan for end user training until late in the effort,” says , TEKsystems vice president of healthcare services. “Upfront training strategy development would allow for the identification of key competencies and performance indicators. As organizations transition from implementation to day-to-day operations, any deficiencies in the ability to meet the targets can be pinpointed to either a specific user group, department or globally as indicated by analytics and aligning remediation accordingly. Developing an effective adoption strategy is a critical step that needs to be detailed earlier in the process and carried throughout the life of the initiative. That includes finding the appropriate resources necessary for building, integrating and conducting the training.”
Bringing in the right people and skills
Sixty-six percent of respondents cite the challenge of finding the right workers with the right skills for the implementation. More than half struggle with finding the right people to build a training program (57 percent) or lead the classroom discussions (53 percent).
“The supply of HIT talent is not keeping pace with the demand – from clinical trainers, builders and consultants to project and program managers. Finding the necessary resources can be a daunting task for many organizations, but one that is essential to achieving a successful EHR implementation,” continues Kriete. “That includes finding the right principal trainers and scaling to meet the overall training and adoption needs.
Conducting an impactful training experience for the end users
According to more than three-quarters of healthcare professionals, results of poor EHR training implementation include: rework (85 percent), lack of applicability to real-world scenarios (84 percent), low levels of user adoption (84 percent), long learning curves (82%) and inability to leverage the system for meaningful use (77 percent).
“The importance of effective training cannot be overlooked. To avoid these outcomes, organizations must proactively build a customized training program that is led by educators with clinical and technical EHR experience. The training cannot simply be ‘off-the-shelf.’ It should align with the overall organizational goals, workflows, technical requirements and end-user job roles” states Kriete. “One method for ensuring a training program is effective and builds confidence within an organization is to engage end users, those using the system on a day-to-day basis, in the development of the curriculum.”
“In addition to leveraging end users in this process, efforts should be taken to combine synchronous and asynchronous learning methods to foster a learning environment that meets the needs of the adult learner and their hectic schedules and a learning environment that is not bound by space or time” says Von Baker, TEKsystems healthcare practice director.
Including end users in the process
Overall, less than half of clinical end-user stakeholders are deemed completely engaged in the program; even the trainers for the new system are not fully engaged, with only 59 percent reporting their trainers are completely engaged in the process.
“This study shows the majority of executives and decision makers are engaged in the implementation process, but unfortunately, this is not the case with end users. Giving end users the opportunity to provide feedback during the development of and during the training boosts their sense of ownership and increases their confidence in the system post-implementation,” comments Baker.
Continuing to support end users after go-live
More than 50 percent of healthcare organizations anticipate end users will need more than six months to adapt to the new system.
“The work does not stop once the implementation is complete. Providing post go-live support is critical to ensure the end users fully adopt the system. Best practice is to create performance support tools for end users to have ready access to how-to reference guides when the needs arise – self service. The right blend of performance support tools depends on the organizations culture, internal drivers (i.e. varied workflows, varied specialties, and geographically dispersed facilities), and available technology. Underestimating the amount and degree of post go-live support can cause a decrease in productivity and performance and increase end-user frustration,” concludes Baker.
About TEKsystems Healthcare Services
TEKsystems Healthcare Services is dedicated to providing workforce planning, human capital management and IT services to the healthcare industry. Utilizing its suite of services, including EHR Implementation Support, ICD-10 Support and Data Services for BI, Reporting and Data Warehousing, they help healthcare organizations accomplish critical initiatives related to meaningful use, compliance, analytics, network transformation and revenue cycle management.
By the time the market is ready to move, the technology they’ve been told to move to won’t exist as it has been depicted.
This is much the same thing as technology that has been developed that upon its arrival has been pronounced dead. An example of this was the iPad. Before it hit the market analysts and naysayers said the technology – which I don’t have to tell you is essentially a hand-held, touch screen computer – was worthless. No one had a need for PC that one could carry about wherever they went; we had laptops after all. But they failed to see the upside.
For example, iPads are the ideal technology for busy physicians (as you well know) making rounds jumping from patient to patient throughout a practice, as well as have had a profound effect on the treatment and education of individuals with autism and other developmental disabilities.
For example, tablet devices have opened the door for children with special needs, many of whom use them easily and effectively. Not only have they become a learning tool for many of these children, they have also become communication devices. According to Mashable, students using an iPad advance more quickly than those who did not use them. Even in education, there are currently more than 2 million tablets, like iPads, being used and the number will increase dramatically as the technology becomes more accessible and affordable.
As of December 2012, there are more than 20,000 apps for mobile devices that teach communication, speech, language, motor skills, social skills, academic skills, behavioral skills and more than 900 apps for students with disabilities, including autism.
I believe something similar will happen to the patient portal market. Heavily pushed on physicians by EHR vendors for the last three years, this has led to their increased popularity. Meaningful use hasn’t hurt either.
However, by the time the market adjusts to their availability and the reasons for their existence – bill administration, appointment scheduling, viewing records (in some cases) and communicating securely with physicians – the technology as we now know it will no longer exist.
Monique Levy, vice president of research for Manhattan Research recently made an interesting point about the future use of patient portals and I think it’s hard to disagree with her: Today, patient portals are most commonly used for scheduling appointments, viewing medical results and sending messages to doctors or nurses, Levy says. But many more advanced features are not only possible, but are available and waiting to be implemented. This includes access to video chat with a healthcare professional, pre- or post-operative care instruction videos and consolidation of all of a patient’s medical data from multiple sources in one place.
For instance, mobile health technologies will feed patient data directly to the patient portal to improve care and treatment options.
In a lot of ways, this sounds a lot like a Hootsuite interface that used to collate and track all of our social media channels. For example, I can track my Twitter feeds and Facebook pages as well as can interact, post and broadcast content through it. Patient portals are likely moving in this direction and will end up being so much more than the base model systems currently being implemented.
Most likely, the standard bi-directional portals that current vendors produce are likely going to be passé in short order and new systems and interfaces are likely to crop up and take over the market, changing the landscape once again.
Simply stated, perhaps it’s best not to believe all that we’re being told. It may benefits us to think about where our decisions regarding technology investments take us.
To follow the belief that the stale portals of today will match what in the future will most likely be vibrant interfaces may be similar to denying the viability and importance of devices like tablet PCs in healthcare and beyond, though, many thought them worthless at the point of issue.
Guest post by Stein Soelberg, director of marketing, KORE Telematics
As a provider of machine-to-machine (M2M) wireless networking services specifically designed for connecting mHealth solutions, KORE is approached every day with new use-case scenarios where telemedicine can provide life-saving or quality-of-life improving solutions for patients.
Currently, there are many health conditions that are being positively affected by the growth of mHealth applications; however, the top five health conditions for telemedicine treatment are active heart monitoring, blood pressure, diabetes, prescription compliance and sleep apnea.
1. Active heart monitoring. For at-risk patients, wireless heart monitoring devices have already proven to reduce hospitalization through early detection of heart failure. In addition, these devices are able to limit the time that physicians spend looking at data that is not pertinent, since they only send notifications with information that is outside an acceptable range.
2. Blood pressure. Wireless sensor nodes have become cost-effective, compact and energy efficient, which allows for continuous cycle reporting and electronic dispatch in urgent situations. It is important, however, to distinguish in this category between “critical monitoring” and “convenience monitoring.” The former are able to account for stress, eating habits and other external triggers more completely and pinpoint life-or-death issues. The latter are iPhone Apps for the health conscious consumer.
3. Diabetes. Wireless glucose monitoring devices can send alerts to patients and doctors alike when values move outside an acceptable range. These devices can also monitor for dietary intake to help impact a patient’s lifestyle choices.
4. Prescription compliance. On the surface this is an easy one. Patient health risks — and the risk of hospital admission — get greatly reduced by patients taking their medications as directed. But there is also a need to ensure that people take entire drug courses and eliminate the potential for re-prescribing. Literally billions of dollars each year reach their expiration date in patient’s medicine cabinets. Additional intangible benefits include fewer provider phone calls, and even shorter wait times in provider offices, by eliminating visits from improper prescription utilization.
5. Sleep Apnea. The thing that is really interesting about telemedicine devices for sleep apnea is that they can handle both investigatory and direct treatment. The two-way nature of the device can report on sleep patterns, body position and breathing to refine research and treatment course for any given patient. There is a direct cost saving here as well, since the devices directly eliminate the need for expensive Polysomnography exams and limit the need for overnight hospital stays, on an ongoing basis.
These mHealth applications are helping to promote more efficient use of medical equipment and resources, ensuring that devices and medication are being used as prescribed, improving patient outcomes by providing real-time data, improving patient quality of life, decreasing treatment costs and minimizing travel to and from offices and hospitals to allow for ease in care. Overall, the rise of mHealth/telemedicine will drastically and positively affect the lives of patients with a wide variety of health conditions.
Stein leads a team whose responsibility is to own the branding, advertising, customer engagement, loyalty, partnership and public relations initiatives designed to propel KORE into the 21st century. With more than 15 years of technology marketing experience in the business to business software, Internet services and telecommunications industries, Stein brings a proven track record of launching successful MVNOs and building those brands into leaders.
In a recent conversation with Steve Ferguson, vice president of Hello Health, he described how the company is identifying new revenue sources for practices while working to engage patients. Even though the company’s business model is one that sets it apart and helps it rival other free EHRs, like Practice Fusion, I left the conversation with him wondering why more venodrs weren’t trying the same thing as Hello Health: trying something no one in the market is trying to see, if by change, a little innovation helps pump some life into the HIT market.
Along the same lines, myself and thousands of others in HIT have wondered why systems are not interoperable and, for the most part, operate in silos that are unable to communicate with competing systems.
Certainly, there’s a case to be made for vendors protecting their footprints, and for growing them. In doing so, they like to keep their secrets close; it’s the a business environment after all and despite the number of conversations taking place by their PR folks, improving patient health outcomes comes in only second (or third) to making money.
However, let’s move closer to my point. Given the recent rumors that Cerner and McKesson are working on a joint agreement to enable cross-vendor, national health information exchange, I’m wondering: Why don’t other vendors partner now and begin to build interoperable systems.
According to the rumors, the deal, if completed, could shift the entire interoperable landscape for hospitals, physicians and patients. It would position Cerner, which has more EHR users, and McKesson, which has a strong HIE product in RelayHealth with a loyal user base, to take on Epic Systems, a leading EHR vendor.
An announcement is expected at HIMSS13.
Here’s why this is important news: Interoperability mandates are coming. Like most things, it’s really just a matter of time. Systems will be forced to communicate with other, competing systems. They should already. It’s actually a bit shocking that given the levels of reporting required of care givers, the push for access to information through initiatives like Blue Button and patient’s access to information through mobile technology that there’s not more openness in the market.
The Cerner/McKesson news is incredibly refreshing and worth a look. Two major competitors may be realizing that by partnering they’ll be better able to take on each company’s biggest competitor: Epic.
Imagine connected systems exchanging data. The thought alone would be marketable across several sectors of the healthcare landscape and the move worthy of reams of coverage, which would lead to great brand awareness for each and the change to do what all EHR companies aim for: To create thought leaders; to stand out; to set the market on its heels.
If nothing else the partner vendors would stand ahead of the pack when future interoperability mandates are enacted and will be seen as experts in the exchange game. Tongue and cheek aside, the idea really is a good one and with no one currently doing it, it’s a great opportunity for a couple of HIT companies to actually move change forward and create an environment where information can be easily exchanged across practices, across specialties and across borders.
Then, perhaps, we’ll see a real commitment to improved patient health outcomes rather than them simply trying to improve bottom lines.
Guest post byRobert Oscar, R.Ph., founder of RxEOB.
Mobile technology has changed the way we live in dramatic fashion. Now it’s changing the way we access healthcare and medical information. In fact, the popularity of health-related smartphone apps as on-the-go tools has skyrocketed. Our smartphones and other mobile devices have made health and wellness choices simple and convenient.
More people than ever before are finding physicians, managing weight, controlling allergies, looking up symptoms, making doctor appointments and even checking into the hospital through their smartphones. For the house-bound and people living in rural areas, this technology can actually save lives by greatly improving connectivity and access to care, and streamlining self-management of such chronic diseases as diabetes, asthma and high blood pressure.
Health apps can also make medical-financial tasks easier, such as integrating financial data from high-deductible health plans or comparing prices between pharmacies. Furthermore, health apps can help streamline the flow of information between health plans, physicians and patients — making communication easier, quicker and more informative.
At work, employees can take greater control of their own health and work more closely with in-network healthcare providers. This is especially true for those who are looking to save money and reduce their out-of-pocket healthcare expenses.
Today, health-related apps are used mostly for accessing information, with some mobile devices making one-on-one interaction possible. As more hospitals and doctors begin to use apps, they will be able to reach more people with greater efficiency. Along these same lines, apps designed for physicians will become better at connecting to patients’ clinical records so that information can be easily shared — where and when it is need.
The impact of the mobile app revolution is expected to grow. In fact, a recent study found that nearly 17 million consumers were accessing health information on mobile devices in 2011, according to American Medical News, representing a 125 percent increase from 2010. These statistics have experts predicting that healthcare and medical app downloads will reach 44 million this year, and 142 million by 2016.
Consider the example of a large shipping company that participated in a pilot project involving a new mobile health app. Early reports showed that 42 percent of employees who used the app saved money on their prescription drug costs, according to Employee Benefit News. These employees had easy access to prescription drug plan information via their desktop and smartphones. End result, a whopping 71 percent of the participants said they’d recommend the service, and the company savings ranged between $174 and $366 per user per year.
Ultimately, health-related apps and the wealth of information they provide help patients become more engaged in their health so that they can make better choices, cuts costs and, eventually, help ease the strain on the US healthcare system.
Robert Oscar, R.Ph., has more than 25 years of experience in healthcare. Throughout much of his career, Oscar has developed and implemented successful programs to effectively manage pharmacy benefit risk including pioneering work in the Medicare HMO market. Before founding RxEOB more than a decade ago, Oscar worked in the medical information systems industry, designing, developing and implementing several different claims analysis tools. Licensed in Virginia and certified in pharmacy-based immunization, Oscar is a graduate of Ohio Northern University.
I may be preaching to the choir, or, perhaps, I’m speaking to myself. Here I am, a member of the both the health IT community and a member of the PR community. One of my tasks is to help educate and inform those within and those on the outside of the healthcare community about the benefits of technology that’s designed and created for the betterment of physicians, caregivers and patients.
Being in my somewhat unique position, where I publish a site dedicated to healthcare technology and my role as a PR professional, I get to see things from both sides of the fence, in many cases several times in a given day.
I do a lot of pitching to media sources, sending stories and ideas that have been developed by my clients to best educate the community about a plethora of subjects to the media. I live by a credo established by myself to approach the media only with topics I feel are specific, educated and advance the overall conversation about a certain subject. Never do I blindly pitch ideas simply for the sake of landing coverage in obscure outlets.
Perhaps Electronic Health Reporter is an obscure outlet. I’d like to think not. Nevertheless, I get pitched by fellow PR practitioners a lot. More than you might think; several times a day. As regular readers of this site know, I tend to focus on healthcare information technology and it peripheral topics. But, that’s more than I receive from my colleagues for story ideas.
Some of the topics in my inbox are enlightening and some are entertaining; some of completely off topic and some should never have been sent. So, why is this important; why take the time to dedicate to a post about the subject?
Perhaps I’m a purist. Maybe I have a sense of self importance, but I tend to think that the conversations taking place with the media, things that are being positioned for the press by leaders in the HIT community, just might not be what the market – those serving patients and others in the practice of healthcare – really need, want or like.
At its very base, this is the sort of thing that makes me wonder just how much “innovation” there is because those in the position of creating a product for the purpose of selling it to make money are convincing those that are counting on them for the newest products to advance their mission in the field according to innovation and need.
I’m often called a cynic. It’s true. I’m suspicious of a lot of things. It’s something that I developed during my days as a reporter when, like now (as a site publisher and blogger), I get pitched a lot of stories that were not worthy of my time.
I’ve got to admit, I’m surprised by this disconnect. It’s somewhat eye opening to me that the vendors serving the healthcare community seem so far from synched up with those actually providing the care.
If I’m wrong, I hope you’ll let me know. If I’m right, I promise not to be part of the problem.
According to a recent report issued by KLAS Research, “Patient Portals 2012: The Path of Least Resistance,” published by HIT Trends health systems and practices are turning to patient portals more than ever before. Meaningful use is an obvious reason, but convenience and “the ease of integration that comes from having an established relationship with an EHR vendor are the primary factors providers use to choose a patient portal.”
In light of the expanding need of patient portals, the KLAS study focused on solutions that providers use, and what role the portals play in the long-term strategies each organization for patient engagement. The report included respondents from a mix of health systems, hospitals, and clinics.
“Providers are feeling increased pressure to engage with their patients at deeper levels than ever before. About one-half of interviewed providers already had a portal in place, primarily from their current EHR vendor. Providers needing to connect a number of disparate EHRs were the only group more likely to opt for a best-of-breed solution.”
“The existing EHR vendor relationship appears to be more important than any other factor when choosing a patient portal,” said report author Mark Allphin. “While functionality and ease of use are important to providers, they take a backseat compared to providers’ desire to manage fewer vendors and interfaces.”
Although many providers are choosing to stay with incumbent EHR-based patient portals, KLAS did report significant interest and engagement with third-party vendors.
Access to the patient clinical record is the most implemented function. Other functions in place or planned include: appointment scheduling, provider messaging, bill pay, online registration and patient education.
Of those interviewed for the report, 57 percent of providers surveyed report a patient portal in place.
According to Michael Lake, publisher of the monthly healthcare IT newsletter, HIT Trends sums up the report this way: “Providers are putting patient portals in place to meet meaningful use requirements for access and messaging. Some are looking at kiosks and mobile solutions, too. In single EHR organizations, using portals from their current vendor makes tactical sense. Niche solutions may fare better when providers look at long-term strategies and required functionalities.”
From my perspective, and probably yours, serious portal conversations have taken place for about the last three years, and with the mandates of meaningful use, it was only a matter of time before they started to proliferate the market.
Even as practices look to engage their patients more, portals will likely be the first tool considered to do so. As the report suggests, the biggest question here may be whether to add a portal from your current vendor or to find a third-party solution.
Are you going through a portal implementation? What’s your strategy going to be?
According to a recent report issued by KLAS Research, “Patient Portals 2012: The Path of Least Resistance,” published by HIT Trends health systems and practices are turning to patient portals more than ever before. Meaningful use is an obvious reason, but convenience and “the ease of integration that comes from having an established relationship with an EHR vendor are the primary factors providers use to choose a patient portal.”