Comments on: New Physician Adoption Statistics http://healthit.hhs.gov/blog/onc/index.php/2010/01/26/new-physician-adoption-statistics/ Office of the National Coordinator Thu, 18 Mar 2010 22:58:36 +0000 http://wordpress.org/?v=2.9.2 hourly 1 By: Plumber http://healthit.hhs.gov/blog/onc/index.php/2010/01/26/new-physician-adoption-statistics/comment-page-1/#comment-686 Plumber Thu, 18 Mar 2010 20:58:53 +0000 http://healthit.hhs.gov/blog/onc/?p=154#comment-686 When you consider that we are in the 21st Centuary, a life style which is based around digital services and media, you would have thought that something would have now been kicked into shape… as it is, the problems are from the paper waste, because it is costing the Government more and more each year, to recycle something which is clearly not bringing in any revenue, and costs about $60+K each year to manage. Dread to think how much of an easy life they have, when you consider how much free junk we get through the mail box every day! very well said totally agree with you 100% When you consider that we are in the 21st Centuary, a life style which is based around digital services and media, you would have thought that something would have now been kicked into shape… as it is, the problems are from the paper waste, because it is costing the Government more and more each year, to recycle something which is clearly not bringing in any revenue, and costs about $60+K each year to manage.

Dread to think how much of an easy life they have, when you consider how much free junk we get through the mail box every day!

very well said totally agree with you 100%

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]]> By: EHRSupporter http://healthit.hhs.gov/blog/onc/index.php/2010/01/26/new-physician-adoption-statistics/comment-page-1/#comment-672 EHRSupporter Thu, 11 Mar 2010 03:18:00 +0000 http://healthit.hhs.gov/blog/onc/?p=154#comment-672 As I read through all of these comments I feel as though I am hearing some very good discussion surrounding what may be "missing" from ARRA as well as challanges that providers face in adopting EHR's. I would, however, like to add a few things for consideration from a different perspective. As someone who works as an HIT project manager, I have worked with varying sized ambulatory clinics in implementing EHR's. Outside of hurdles with the software itself, which will be had regardless of the software purchased (one must remember that it is software), there are several critical factors that are often missed by providers/administrators. This is not just my perspective, I attended a seminar last week in which someone shared the stat that EHR implementations fail 70% of the time on the initial try. I believe there is also numerous data and horror stories available on the web to support the fact that EHR adoption is a difficult task. What has me most excited about ARRA is the whole idea of improving patient care, along with interoperability. Implementing EHR's is not just for the sole purpose of sharing data (as someone here suggested), there are enormous benefits to having systems that can alert providers to contraindications, manage care for high risk patients, manage health maintenance, or streamline workflows, etc... Things which are extremely difficult to manage in an accurate and effective manner in the paper world. What has me least excited about ARRA is the "rush" to implement so as to collect funding. I would not be surprised to see the 70% failure rate increase dramatically as an unintended side-affect of ARRA. The reality is that for practices who have not yet purchased an EHR today, or not yet begun their implementation, it is HIGHLY unlikely that they will be "meaningful" users by 2011 or even 2012 at that. This will be due to a poorly planned and poorly executed implementation, or simply put a rushed implementation. Some of the most fatal errors in EHR implementations, which I have personally experienced: 1) Underestimating time committments 2) Expecting the software to conform to unique workflow/practice needs without hurdles or human intervention 3) Reducing vendor training as a means of "saving" (this almost always ends up costing practices much more) 4) Purchasing an EHR without buy-in from physicians, or heavy involvement in the implementation 5) Tyring to implement too much, in too short a time frame 6) Not having an internal Project Manger (who can devote 25 - 75% of their FTE to the project - dependant on practice size) 7) Forgetting that the software is software - some processes that were completed in the paper world will simply need to continue to be done manually - EHR's do not offer mind-reading functionality and will not prepare the coffee in the morning 8) Lack of communication 9) Scope creep 10) Inadequate resources - both monetary and human Personally I would like to see a at least one change to the current proposed rules for meaningful use. Due to the existing low adoption rate of EHR's, I believe the phase one expectations are too high. Perhaps allowing EP's to meet a certain percentage of the 25 criteria the first year would be better - something around 60%? This may help providers keep focused on actually implementing in a meaningful way rather than cramming everything in just to try to meet the criteria. As far as the certification of EHR's - all I can say is IT'S ABOUT TIME! As I read through all of these comments I feel as though I am hearing some very good discussion surrounding what may be “missing” from ARRA as well as challanges that providers face in adopting EHR’s.

I would, however, like to add a few things for consideration from a different perspective. As someone who works as an HIT project manager, I have worked with varying sized ambulatory clinics in implementing EHR’s. Outside of hurdles with the software itself, which will be had regardless of the software purchased (one must remember that it is software), there are several critical factors that are often missed by providers/administrators. This is not just my perspective, I attended a seminar last week in which someone shared the stat that EHR implementations fail 70% of the time on the initial try. I believe there is also numerous data and horror stories available on the web to support the fact that EHR adoption is a difficult task.

What has me most excited about ARRA is the whole idea of improving patient care, along with interoperability. Implementing EHR’s is not just for the sole purpose of sharing data (as someone here suggested), there are enormous benefits to having systems that can alert providers to contraindications, manage care for high risk patients, manage health maintenance, or streamline workflows, etc… Things which are extremely difficult to manage in an accurate and effective manner in the paper world.

What has me least excited about ARRA is the “rush” to implement so as to collect funding. I would not be surprised to see the 70% failure rate increase dramatically as an unintended side-affect of ARRA. The reality is that for practices who have not yet purchased an EHR today, or not yet begun their implementation, it is HIGHLY unlikely that they will be “meaningful” users by 2011 or even 2012 at that. This will be due to a poorly planned and poorly executed implementation, or simply put a rushed implementation.

Some of the most fatal errors in EHR implementations, which I have personally experienced:
1) Underestimating time committments
2) Expecting the software to conform to unique workflow/practice needs without hurdles or human intervention
3) Reducing vendor training as a means of “saving” (this almost always ends up costing practices much more)
4) Purchasing an EHR without buy-in from physicians, or heavy involvement in the implementation
5) Tyring to implement too much, in too short a time frame
6) Not having an internal Project Manger (who can devote 25 – 75% of their FTE to the project – dependant on practice size)
7) Forgetting that the software is software – some processes that were completed in the paper world will simply need to continue to be done manually – EHR’s do not offer mind-reading functionality and will not prepare the coffee in the morning
8) Lack of communication
9) Scope creep
10) Inadequate resources – both monetary and human

Personally I would like to see a at least one change to the current proposed rules for meaningful use. Due to the existing low adoption rate of EHR’s, I believe the phase one expectations are too high. Perhaps allowing EP’s to meet a certain percentage of the 25 criteria the first year would be better – something around 60%? This may help providers keep focused on actually implementing in a meaningful way rather than cramming everything in just to try to meet the criteria. As far as the certification of EHR’s – all I can say is IT’S ABOUT TIME!

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]]> By: Surgery Houston http://healthit.hhs.gov/blog/onc/index.php/2010/01/26/new-physician-adoption-statistics/comment-page-1/#comment-656 Surgery Houston Sat, 06 Mar 2010 00:09:47 +0000 http://healthit.hhs.gov/blog/onc/?p=154#comment-656 Seems like this is behind the curve when compared to the forward thinking of other industries. Seems like this is behind the curve when compared to the forward thinking of other industries.

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]]> By: EdmundEcho http://healthit.hhs.gov/blog/onc/index.php/2010/01/26/new-physician-adoption-statistics/comment-page-1/#comment-631 EdmundEcho Wed, 03 Mar 2010 04:30:10 +0000 http://healthit.hhs.gov/blog/onc/?p=154#comment-631 Great comment. Would love to learn more about how you see the next gen EMR addressing your concerns. Great comment. Would love to learn more about how you see the next gen EMR addressing your concerns.

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]]> By: Nancy E.B. Ness MD http://healthit.hhs.gov/blog/onc/index.php/2010/01/26/new-physician-adoption-statistics/comment-page-1/#comment-630 Nancy E.B. Ness MD Wed, 03 Mar 2010 03:02:33 +0000 http://healthit.hhs.gov/blog/onc/?p=154#comment-630 (1) Is there a reason that Physician Assistants (PA's) are not included in the ARRA as eligible providers? In our clinics we have 15 PA's and 15 FP physicians -- but we cannot access stimulus funds on behalf of the PA's. If this is an accident, it should be corrected If it is a deliberate omission -- we do not understand the rationale, since Nurse-Practitioners are specifically included. (2) Is there a reason that Rural Health Clinics (RHC's) are, for all practical purposes, excluded from receiving ARRA HIT stimulus funding? The closely related FQHC's / Community Health Centers receive specifically designated benefits. RHC's are located in rural areas which generally have high proportions of elderly patients, covered by Medicare. However, RHC's are required to bill Medicare Part A, not Part B, for services. Therefore RHC's cannot access any significant funds under the Medicare provisions of the ARRA. Furthermore, since the rural areas have such a preponderance of elderly, the proportion of patients on Medicaid, or uninsured, will be lower than in an area with a more average population age. RHC's are required to employ a PA at least 50% of its hours of operation, furthermore eliminating access to funds. (3) Since these problems lie within the ARRA provisions, it isn't clear if they can be corrected without legislation. They essentially disenfranchise a large part of the "safety net" clinics -- and inappropriately discriminate against one class of providers, who are much needed in meeting primary care access goals. (1) Is there a reason that Physician Assistants (PA’s) are not included in the ARRA as eligible providers? In our clinics we have 15 PA’s and 15 FP physicians — but we cannot access stimulus funds on behalf of the PA’s. If this is an accident, it should be corrected If it is a deliberate omission — we do not understand the rationale, since Nurse-Practitioners are specifically included.
(2) Is there a reason that Rural Health Clinics (RHC’s) are, for all practical purposes, excluded from receiving ARRA HIT stimulus funding? The closely related FQHC’s / Community Health Centers receive specifically designated benefits. RHC’s are located in rural areas which generally have high proportions of elderly patients, covered by Medicare. However, RHC’s are required to bill Medicare Part A, not Part B, for services. Therefore RHC’s cannot access any significant funds under the Medicare provisions of the ARRA. Furthermore, since the rural areas have such a preponderance of elderly, the proportion of patients on Medicaid, or uninsured, will be lower than in an area with a more average population age. RHC’s are required to employ a PA at least 50% of its hours of operation, furthermore eliminating access to funds.
(3) Since these problems lie within the ARRA provisions, it isn’t clear if they can be corrected without legislation. They essentially disenfranchise a large part of the “safety net” clinics — and inappropriately discriminate against one class of providers, who are much needed in meeting primary care access goals.

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]]> By: HITA http://healthit.hhs.gov/blog/onc/index.php/2010/01/26/new-physician-adoption-statistics/comment-page-1/#comment-585 HITA Fri, 19 Feb 2010 19:37:46 +0000 http://healthit.hhs.gov/blog/onc/?p=154#comment-585 It amazes me the resistance physicians have to EMR. Not every EMR is a great product. Most are template driven and extremely rigid in their workflow and expensive to customize. But there are those that will adapt and learn from the user and very are easy to customize. My suggestion would be to look for those solutions that are non-template. Seriously, there are tremendous benefits to a digital record over paper charts for the patients, payors and yes even the doctors. Until the doctors get on board these benefits won't be realized by anyone. It amazes me the resistance physicians have to EMR. Not every EMR is a great product. Most are template driven and extremely rigid in their workflow and expensive to customize. But there are those that will adapt and learn from the user and very are easy to customize. My suggestion would be to look for those solutions that are non-template. Seriously, there are tremendous benefits to a digital record over paper charts for the patients, payors and yes even the doctors. Until the doctors get on board these benefits won’t be realized by anyone.

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]]> By: A Cavale http://healthit.hhs.gov/blog/onc/index.php/2010/01/26/new-physician-adoption-statistics/comment-page-1/#comment-576 A Cavale Thu, 18 Feb 2010 05:01:58 +0000 http://healthit.hhs.gov/blog/onc/?p=154#comment-576 How true. I have been talking to walls for years about the same things. However, we have a very neat EMR product that we have successfully used to create our own work flow in our office for almost 6 years. But most IT vendors really don't care to do it. They would rather have you change your methods to adapt to their product. How true. I have been talking to walls for years about the same things. However, we have a very neat EMR product that we have successfully used to create our own work flow in our office for almost 6 years. But most IT vendors really don’t care to do it. They would rather have you change your methods to adapt to their product.

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]]> By: HouseWhisperer http://healthit.hhs.gov/blog/onc/index.php/2010/01/26/new-physician-adoption-statistics/comment-page-1/#comment-564 HouseWhisperer Sat, 13 Feb 2010 02:15:47 +0000 http://healthit.hhs.gov/blog/onc/?p=154#comment-564 Why is no one talking about how lousy available options are for capturing the essence of the clinical encounter--the narrative? I have spoken to countless Health IT folks who still can't grasp my workflow and needs. Just follow me around an ER for a day. In all these Health IT chat rooms a bunch of computer people scratch their heads wondering why we're not adopting EMR faster. Well, why isn't EMR adapting to our workflow? Until I see an app with a simple clean interface, patient tracking, easy-to-access MPH, that I can carry around with me, write on, dictate into, capture the essence of my patient encounter as a single legal document--oh wait, that would be a paper chart and a dictaphone. Seriously.

Why is no one talking about how lousy available options are for capturing the essence of the clinical encounter–the narrative? I have spoken to countless Health IT folks who still can’t grasp my workflow and needs. Just follow me around an ER for a day. In all these Health IT chat rooms a bunch of computer people scratch their heads wondering why we’re not adopting EMR faster. Well, why isn’t EMR adapting to our workflow? Until I see an app with a simple clean interface, patient tracking, easy-to-access MPH, that I can carry around with me, write on, dictate into, capture the essence of my patient encounter as a single legal document–oh wait, that would be a paper chart and a dictaphone. Seriously.

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]]> By: AMH in Missouri http://healthit.hhs.gov/blog/onc/index.php/2010/01/26/new-physician-adoption-statistics/comment-page-1/#comment-546 AMH in Missouri Tue, 09 Feb 2010 21:47:22 +0000 http://healthit.hhs.gov/blog/onc/?p=154#comment-546 Electronic records are certainly a step in the right direction. If this data can mined anonymously in order to establish comparative effectiveness with certain chronic conditions then all the better. It would also be nice if IT was a small part of lowering overall health costs when combined with other initiatives.

Electronic records are certainly a step in the right direction. If this data can mined anonymously in order to establish comparative effectiveness with certain chronic conditions then all the better. It would also be nice if IT was a small part of lowering overall health costs when combined with other initiatives.

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]]> By: Arvind Cavale, MD http://healthit.hhs.gov/blog/onc/index.php/2010/01/26/new-physician-adoption-statistics/comment-page-1/#comment-544 Arvind Cavale, MD Tue, 09 Feb 2010 03:44:39 +0000 http://healthit.hhs.gov/blog/onc/?p=154#comment-544 Adele, you are missing the forest for the trees, here. The basic objective of an electronic medical universe is to be able to share information/opinions/consultations/recommendations, etc. electronically. When CMS kills the one process that encourages sharing of information, the whole argument falls on its face. What this Dept of HHS is telling the practicing physician is that this is just lip service. Removal of consultation codes is at the heart of this problem. By the way, pay-for-service and pay-for-value need not be mutually exclusive; it could be pay-for- valuable service, as it should be. Unfortunately, simply using EHRs does not mean high value service, and vice versa. And, as any clinician can attest, claims submission is a very different process from providing and documenting medical care. Trust me, coming from an 8-year EMR user, that the technology has a long way to go to even come close to providing appropriate solutions to medical practice, because practice of medicine is an art form, not simple science, and computers and technology have a long way to go in matching the needs of the clinician with appropriate solutions. Vendors are simply interested in selling bits and pieces and nickle & diming their customers. Our reimbursements needs to go much higher (not lower as CMS plans to do) if we have to afford the expensive technology of today. And the worst thing the government could have done was to legislate EHR. Society will loose great clinicians because of this; and we will be left with are doctors that are great with computers and documenting, but without much clinical skills; until a whole new generation of doctors are trained/groomed into balancing these two qualities (my optimistic assumption).

Adele, you are missing the forest for the trees, here. The basic objective of an electronic medical universe is to be able to share information/opinions/consultations/recommendations, etc. electronically. When CMS kills the one process that encourages sharing of information, the whole argument falls on its face. What this Dept of HHS is telling the practicing physician is that this is just lip service. Removal of consultation codes is at the heart of this problem.

By the way, pay-for-service and pay-for-value need not be mutually exclusive; it could be pay-for- valuable service, as it should be. Unfortunately, simply using EHRs does not mean high value service, and vice versa. And, as any clinician can attest, claims submission is a very different process from providing and documenting medical care. Trust me, coming from an 8-year EMR user, that the technology has a long way to go to even come close to providing appropriate solutions to medical practice, because practice of medicine is an art form, not simple science, and computers and technology have a long way to go in matching the needs of the clinician with appropriate solutions. Vendors are simply interested in selling bits and pieces and nickle & diming their customers. Our reimbursements needs to go much higher (not lower as CMS plans to do) if we have to afford the expensive technology of today. And the worst thing the government could have done was to legislate EHR. Society will loose great clinicians because of this; and we will be left with are doctors that are great with computers and documenting, but without much clinical skills; until a whole new generation of doctors are trained/groomed into balancing these two qualities (my optimistic assumption).

Hot debate. What do you think? Thumb up 5 Thumb down 3 (+2)

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