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The Coming Physician EHR Revolt

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From my blogging viewpoint I’m sensing a growing discontent among doctors that is starting to really heat up. I can’t quite predict when this discontent will reach a boiling point that will start to boil over, but the fireworks are coming. As I’ve watched the past couple years, doctors were first overwhelmed with all the government regulations. They were confused by everything was coming out and really just didn’t know where healthcare IT and EHR was headed. That overwhelmed confusion is slowly turning into a reality that many doctors are realizing is changing how they practice medicine. If you’re not seeing this, then you might want to get out and spend some more time with your casual every day doctors.

One doctor emailed me today suggesting that doctors were being literally “eaten alive” as they are working harder to provide patient centered care. It would be a disservice to doctors if we don’t take the time to acknowledge and understand the enormous pressures that many doctors are feeling right now.

Here’s a quick look at what I believe is the perspective of many doctors I connect with on a daily basis.

Regulations
Everywhere doctors look they’re getting hammered by new regulations. I recently heard Shahid Shah say, “We’re experts in the industry that spend all day thinking about the market and regulations and even we have a challenge understanding what’s going on. Now think about the doctors and adminstrators which have challenging day jobs and only a small amount of time to understand the regulations. They don’t really understand the details of what’s being regulated.”

This is a reality for many doctors and practices. Is it any wonder that many are happy to sell off their practices to major hospitals? I’m sure that many do so just because they’re tired of trying to understand all the changing regulations they’re required to know.

If we look at just the healthcare IT and EHR related regulations you have: meaningful use, ACOs, ICD-10, 5010, and Obamacare/Healthcare Reform. Any one of those is a challenge to understand and implement. Yet doctors and hospitals are dealing with all five of them simultaneously. Not to mention doctors being asked to participate in HIEs, being graded and rated online, engaging with empowered patients through social media, and embracing a new technology savvy culture while reimbursement lags behind.

Is it any wonder that doctors feel overwhelmed, overworked, and unsure whether they want to continue being doctors. Is this going to lead to a real shortage of medical professionals?

EHR Discontent
Since this is an EHR blog, we should spend some time on the growing discontent with EHR software. I hate to dwell on this, because EHR is going to be the future of clinical documentation. It’s hear to stay and no amount of belly aching and moaning is going to stop EHR software from becoming the de facto standard for clinical documentation. However, just because this is the case doesn’t mean we should ignore the realities that so many doctors are facing when it comes to EHR software today.

Many doctors see EHR as a major time suck. Their EHR software requires them to work longer hours and/or see fewer patients. Overtime this usually improves, but we have to acknowledge the initial productivity hit that pretty much every EHR implementation sees. Some clinics never get back to their previous productivity. We’ve discussed the reasons for this over and over again on this blog. We’ll save the list of reasons and ways to avoid those issues for another blog post. However, until all 300+ EHR vendors solve the EHR productivity issue, we’re going to hear more and more stories of how much of a time suck an EHR is to many doctors.

Not all doctors see it this way. Many doctors can’t imagine their practice without an EHR. As we’ve been covering in our EHR Benefits Series, there are a lot of benefits to having an EHR. Many of the benefits we’ve already covered in that series are ways that a clinic can save time thanks to an EHR. However, it can take time for a new EHR user to get up to speed where they can speak the EMR language well. It’s not easy learning a new language, and so this adds to the growing discontent that many doctors feel towards EHR.

Template EHR and Copy Paste
Many EHR vendors have implemented a complex set of templates that doctors can use to be more efficient. It’s a thing of beauty to see a full template pulled into a patient’s chart with a single click. A full patient physical documented with a single click sounds like it should save the doctors a lot of time and make them more efficient. In fact, many have argued that template based EHR documentation is a great way for doctors to achieve higher reimbursement levels since they are better able to document the actual care they’re providing. In the paper world they would have passed on the higher reimbursement because they didn’t have the time or desire to document all of the items they examined and so they just accept a lower reimbursement level. EMR templates made it possible for doctors to finally be reimbursed for all of the care they provided a patient since the templates made it easy to document.

Sounds great doesn’t it? Well, it did until the government realized that EHR software often drove up their costs. This shouldn’t have been a surprise to anyone in the EHR world. I’ve been writing about the ability to increase your reimbursement rates from EHR for over 7 years. However, instead of the government choosing to acknowledge something that was apparent to many in the industry, they decided to blame the increased costs on, you guessed it, dishonest doctors.

Think about the message that we’re sending doctors. First the government tells doctors to start using EHR. Then, the government calls those doctors dishonest for using the tools that the government told them to use. A doctor recently described their perspective is like being stuck in a pit with sly hyenas all around ready to take their bite out of them.

Add in all the recent discussions about copy and paste in EMR’s, and it shouldn’t be any wonder that doctors are gun shy. When they implement technologies to try and make things more efficient they get their hands slapped or even worse.

Reduced Reimbursement and Penalties
In the midst of all the things mentioned above, doctors are also getting hit with reduced reimbursement rates. This is particularly true for those in the general medicine area. They’re being asked to do more to improve patient care, reduce hospital re-admissions, treat the whole patient, etc and they’re getting less reimbursement.

Plus, now the EHR penalties are hanging over their head if they choose to not show meaningful use of a certified EHR. I still have my doubts that the EHR penalties will be enforced. I expect there will be a whole series of exceptions offered up which make it so pretty much all of the doctors avoid the penalties. However, that’s still unknown and many doctors see those EHR penalties as just another slap into the face.

Data Data Data
Most doctors see the push for EHR as a way for someone to get at the data in healthcare. In many ways, they’re right. EHR’s were first created as big billing machines to get at the financial data. Now with meaningful use, EHR’s are repositories of other healthcare data. The data is being used to optimize reimbursement (rarely a good thing for doctors). The data is wanted for population health analysis. The data is wanted for public health needs. The data is wanted to be able to facilitate ACOs. Everyone wants a piece of the healthcare data it seems.

The problem from a physician perspective is that everyone wants that data, but it’s not often clear how that data is going to facilitate that doctor being a better doctor. In many cases it won’t and there’s the rub. Almost every doctor I know wants to improve healthcare. So, they don’t have any problems supporting initiatives that improve healthcare, but I think that most of them also sit back and wonder at what cost.

Audits
I don’t know anyone that likes audits. Yet, most doctors are surrounded by a wide variety of audits. RAC Audits are on the way. HIPAA audits are possible and HIPAA is always lingering in the back of most doctors minds. Especially when you start talking about technology and HIPAA. There are so many unknowns that there’s no place of comfort for those doctors who want to be compliant. Most make a best effort and then push it out of their minds as they try to provide great patient care. Next up our meaningful use audits. You can be sure they’re coming.

Solutions
I wish I could say that I have a bunch of really good solutions available. What does seem clear to me is that most of the challenges that doctors face revolve around the current reimbursement models that we have today. I’m not sure we can fundamentally change those. One interesting option that’s emerging is concierge medicine.

Every doctor I know loves the idea of concierge medicine. When you tell them they don’t have to worry about reimbursement, insurance companies, etc, you see this huge weight lifted off of their shoulders as they wonder what life would be like for them if all they did was provide the best patient care to those who came to their office. The problem with concierge medicine was highlighted in a tweet I saw recently that said, “Concierge Medicine – Does it really work?”

The answer to that question is: it’s still too early to know for sure. Although, my prediction is that concierge medicine will work in certain situations and communities, but won’t be able to provide the widespread change of reimbursement that we need for healthcare to alleviate doctors concerns.

When it comes to EHR, concierge medicine is quite interesting. None of the mainstream EHR vendors really work for concierge medicine since they’re all focused around reimbursement and concierge throws that out the window. Plus, think about how few of the meaningful use requirements a concierge medicine clinic cares about. In fact, implementing many of the meaningful use and EHR certification requirements gets in the way of the concierge doctor’s workflow. I expect many doctors would love a concierge focused EHR software.

The other solution is likely going to be EHR vendors yielding to the idea that they’re the database of healthcare. Once they make this decision, EHR vendors can really open up the proverbial EHR kimono and let outside developers really make their EHR useful for doctors across all specialties, all regions, all sizes, and every unique workflow. One company can’t satisfy every doctor the way a community of empowered developers can.

No One Feels Bad for Doctors
I’ve written about this idea before, but almost no one feels bad for what most people think of as “well paid doctors.” Far too many doctors are still driving around Mercedes and BMW’s for most people to feel too bad for them. Compared to many people who don’t have a job at all, I don’t feel bad for them either.

While we don’t have to feel sorry for them, that doesn’t mean we shouldn’t acknowledge the pressures that doctors are facing. Plus, I see this only getting worse before it gets better. As an entrepreneur, I see this as a tremendous opportunity. Plus, I see a number of companies that are working to capture this opportunity. However, far too many companies are blind to this physician discontent. I’m not sure if it’s purposefully blind, ignorantly blind, or arrogantly blind, but many are ignoring it. As I predicted in the beginning of this post, I see this reaching a boiling point soon which leads to some fireworks.

Let me highlight what I’m talking about using the words of a doctor’s message I literally received in my email as I was writing this post:

EMR’s are making it more and more difficult to practice medicine. They used to be fun and helped my daily work. Now, they are getting so complex that is takes much more time to do them. MU is becoming a nightmare for physicians.

February 5, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Personalized Medicine – Processing Millions of Health Data Points

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“When you go to the doctor’s office and they do a blood test, they typically measure no more than 20 things. With the technology out there now, we feel you should be able to measure thousands if not tens of thousands if not ultimately millions of things. That would be a much clearer picture of what’s going on.”

This quote comes from a fascinating article by Jon Cohen called, “Examining his own Body, Stanford Geneticist Stops Diabetes in Its Tracks.” The idea is simple, but extremely powerful. I think it also paints a clear future for healthcare.

Michael Snyder is right that we need to have tens of thousands and ultimate millions of data points to be able to really effectively treat the human body. When I start to think about this, it actually makes me proud that the medical profession can treat a patient as well as it does with such limited information. Yet, it also gives me great optimism that the best advances in healthcare are still ahead of us.

As I’ve mentioned multiple times before, I believe that the body of medical knowledge will become too complex for the human mind to process on its own. In fact, we might already be there today. When you add in thousands and eventually millions of additional data points, then no one could even start to question this idea.

How then will we be able to process all these data points? Despite the human minds amazing characteristics, it will have to be assisted by technology. The human mind won’t likely be taken out of the equation, but computing power will assist the human mind to make much better decisions.

One problem with this idea is that the EHR software of today aren’t designed to handle this type of processing. EHR software is the database of healthcare and some might say that’s even a stretch. Does that mean that we’re going to have to deploy a new wave of software and technology to support this type of smart healthcare data processing?

July 19, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

EHR Is the Database of Healthcare

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I’ve been regularly writing and thinking for the past few months about something I’ve branded as the “Smart EMR.” Basically, the EMR of the future won’t be a repository of documents and information like before. Instead, doctors will have an expectation that the EMR is smart and can do something valuable with all the health information that’s stored in the EMR. I love this subject. I should put together a presentation on it and start touring it around the country, but I digress.

While at HIMSS I had the pleasure of talking with Sean Benson, VP of Innovation at Wolters Kluwer Health. In our discussion, he said something that hit me like a ton of bricks. He suggested that EHR software is the database of healthcare. The implication being that EHR software is good at collecting healthcare data and storing that data. What they’re not good at doing is actually providing the smart layer that goes on top of that data.

I’m sure that many who know about Wolters Kluwer Health’s (WKH) software offerings might see Sean’s view as bias since WKH, as best I can tell, wants to be the smart layer that goes on top of EHR software. In fact, they showed me some really interesting technology they have for processing all the medical information out there into a really digestible format, but that’s a post for another day. Their interests and clinical decision support software aside, the idea of the EHR software being the database of healthcare seemed to resonate with me.

I’ve often described EHR software to date as a big billing engine. Some EHR are trying to break that mold, but that’s a hard mold to break since a big billing engine is what the market has asked them to create (for the most part). With that in mind, it’s certainly hard for an EHR software to develop a true Smart EHR platform.

I can see in my mind’s eye a product development team going into the EHR vendor executives office and pitching some amazingly smart and effective EHR software for improving patient care. The cynical me then sees the EHR vendor executive saying, “We can’t monetize that.” or a related “That won’t sell more EHR.” The sad thing is that the executive is probably right…at least today. The market hasn’t started demanding a Smart EHR and improved patient care. I’m hopeful that the new ACO model will help to shift that focus, but it’s still too early to tell if that will provide the impetus for change.

Another part of me hopes that a true entrepreneur will come along and build an EHR that provides such a stark contrast in how it provides patient care that doctors won’t be able to resist using it. Something impactful like the stethoscope, that if a doctor isn’t using it patients won’t go to that doctor. However, this line of thinking seems to push the concept of EHRs being the database of healthcare and not the All in One Smart EHR.

If I’m an entrepreneur with the vision of transforming patient care through smart use of EHR data, why would I want to build an EHR from the ground up when there are a number of very large EHR vendors that have APIs that allow me to build upon their data? If the data’s already been collected, then I’m likely to focus all of my energy creating innovative solutions with that data, not creating the mechanism to collect the data.

What’s a database? Tools to collect data, store data and then retrieve data. What’s an EHR today? Mechanisms to collect health data, store the data and then retrieve the data.

Ok, that’s a bit of an over simplification, but the analogy is there. You can see why so many EHR vendors are trying to become “the platform” of healthcare. Turns out that being the repository of data that everyone else builds cool stuff on top of is very valuable. However, building that platform requires a very different culture and focus than building Smart EHR solutions.

This is why I’m sure many EHR vendors will try to develop some Smart EHR solutions, but in the end EHR will be the Database of Healthcare that other Smart EHR applications connect into. I don’t think that’s a bad thing at all.

March 1, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.