EMR Adoption | EMR and HIPAA

EMR Market Topped $20B Last Year

As we all know, last year was a huge year for EMR adoption. How big? Well, according to new data from research firm Kalorama Information, the EMR market hit $20 billion in 2012, driven by health IT upgrades and the desire for Meaningful Use incentive payments.

According to Kalorama, the EMR market was $20.7 billion last year, up 15 percent from the $17.9 billion it reached in 2011. These numbers include revenue for EMR systems, CPOE systems and directly-related services such as installation, training, servicing and consulting.

Kalorama expects near year to be big as well, as providers implement EMR systems in an effort to avoid government penalties for sticking to paper charts.

More than $12.3 billion in Meaningful Use incentive payments had been doled out to 219,000 eligible hospitals and healthcare professionals as of March 1, 2013, with the incentives largely driving physician adoption of EMRs.

A recent CMS study reported that over 70 percent of physicians have used EMR systems, a huge jump from the 26 percent which had used these systems in 2006. Hospital EMR installlations, meanwhile, have been maturing, with 77 percent having reached Stage 3 or higher, compared with 71 percent in 2011.

Going forward, Kalorama predicts that EMR adoption will continue to increase, that hospital adoption will be more rapid than physician adoption and that hospitals currently at adoption Stage 3 will continue to increase their engagement with their systems. The research firm also predicts that current EMR owners will be upgrading their systems.

Meanwhile, researchers say, the threat of penalties for failing to use EMRs meaningfully will force both doctors and hospitals to make upgrades over the next year or so.

While Kalorama doesn’t mention this, the next year or two is also likely to be marked by “the big switch,” with doctors in particular changing out systems that haven’t proven effective to date. The likelihood that doctors will be buying new systems is likely to lead to a gangbuster year for ambulatory HIT vendors.

The False Economies of EMR

Written by: John Lynn

In my recent look around the EMR twittersphere on EMR & EHR, I briefly commented on the challenges of choosing the wrong EMR and EMR Switching. Dan Haley from athenaHealth asked for some deeper clarification of my comment, “I’d say the biggest driver of EMR switching is thanks to the EHR incentive money and meaningful use.”

Here was my response:

I think there are a whole list of things in the HITECH act which encourage and promote the use of outdated technologies. I’m sure this is something you agree with and know all about as well.

My core argument has been, sure we’re seeing an increase in EHR adoption. However, what if the EHR incentive money is incentivizing doctors to adopt the wrong EHR. By wrong EHR I mean one that they don’t like, that can’t adapt to changing technology, that can’t support the future Smart EMR requirements that are bound to come, that kill a physician’s workflow, that cause a doctor to not want to be a doctor, etc.

I think we may be headed this direction and the number of doctors switching EHR software is a decent example of why this is the case. I’m sure that some would argue that meaningful use is driving people to switch EHR software and that the switch we’re seeing happening is from EHR software that isn’t highly functional to EHR software that is highly functional.

While this argument is true in some cases, there are just as many cases which illustrate that the EHR switching was because their first MU EHR was such a terrible experience that they had to switch EHR. Plus, we’re just at the start of this. Many are painfully grinding through the day to day with an EHR they hate. Wait until that explodes.

Even worse is those clinics that are switching EHR for the sake of EHR incentive money and go from an EHR they enjoy to one they hate. Add in the many doctors who are stuck using an EHR that was selected by some large company who didn’t worry too much about the physician needs and we’re in for a crazy next couple years.

Hopefully this gives you a better idea where my comment was coming from. Needless to say, I’m not sure that HITECH has been a benefit to doctors. The short term numbers might look good, but it might have just created some painful underlying difficulties going forward.

With all of this said, there are some beautiful EHRs out there that make doctors lives better. I’m pro-EHR when it’s done right. I just don’t see meaningful use and EHR incentive promoting the right EHR adoption methods.

This provided some interesting background for a conversation I had recently with a doctor. He told me, “It seems like there are a number of false economies driving EMR adoption.”

I think meaningful use and EHR incentive money driving EHR adoption is a false economy. This doctor described to me how many of his colleagues weren’t using the EHR that they wanted, but instead were using an EHR that they “had” to use. What are some of the forced requirements for EHR that create these false economies besides meaningful use and EHR incentive money?

Another False EMR economy is around HIE connections. Many doctors can’t select the EHR they want to use and fits their workflows best because their local HIE may or may not choose to support a connection with that EHR. So, the doctor opts for an EHR that does connect with the local HIE even though it wasn’t their EHR choice.

Hospital Connections is another false economy. Similar to an HIE, many doctors will opt for what they consider to be a less than desirable EHR because it’s the one that works with their local hospitals.

I’m not trying to pretend that doctors should be the end all be all in EHR selection. A physician can think one EHR is the best and not realize until after using it that another EHR would have been better. Sometimes you think you have a great EHR until you actually use another one and realize what you’re missing. However, the easiest recipe for disaster with EHR is for a doctor to hate using an EHR. As I mention above, it will not end well and will drive the future EMR switching that I’ve predicted.

Yes, Healthcare IT Adoption Is Expensive AND Painful!

Written by: Mandi Bishop

<Mandi’s Rant>

Few topics infuriate me as much as the notion that national standards-based implementation and adoption of healthcare IT should be cheap and easy. Haven’t we all heard the adage, “You can only have things done two of three ways: fast, cheap, or well”? Considering that the “thing” we’re trying to do is revolutionize the healthcare industry, the effects of which may be felt in each and every one of our lives at some point, don’t you want to include “well” as the bare minimum of what is required? After all, this is YOUR electronic health record, YOUR data, YOUR treatment plan and effectiveness measurements. So, what’s the other way we want this “thing” done: fast or cheap?

We’re talking about an industry that takes an average of 17 YEARS to put significant medical discoveries into routine patient care practice. (Numerous sources confirm this: The Healthcare Singularity and the Age of Semantic Medicine Translating Research into Public Health Action, etc.)

17 years is an entire generation of doctors. Doogie Howser could have been born, graduated med school, and begun to practice medicince by the time any insights from his birth were applied to practice. Suffice it to say, “fast” is not a way that healthcare is used to doing a “thing”.

Let’s contrast that with the information technology industry’s acceptance of iterative development releases and planned obsolescence for enterprise AND consumer assets. The big boys (Oracle, IBM, etc.) generally cease support of older products between 7-10 years after their introduction. Your company’s AS/400 server hardware may be 15 years old, but the O/S is the latest release, and all the data on the legacy server is preserved with the latest in backup packages over a wire-speed network connection. How long have you had your laptop? How frequently have you updated your Facebook app this year?

If someone tried to sell you a 17 year-old 480DX PC with a 9600 baud modem, 5″ floppy disk, 64MB RAM, running Windows 3.11 using the argument that, although much newer, faster, cheaper, more effective technology is available it is not yet PROVEN, would you buy it?

So, healthcare – an industry which moves at the speed of 17 years of Doogie Howser medical student maturity, and technology – an industry reinvented with the introduction of the iPhone in June of 2007, are at a crossroads for how to accomplish this “thing”: developing, implementing, and widely adopting national standards-based healthcare IT within mandated timelines that fall well within the next 10 years.

It must be done “fast”, relative to the usual pace of healthcare change.

And it must be done “well”, because it is OUR health at stake.

Suffice it to say, it will not be “cheap”. And my momma always told me that nothing worth doing is easy.

We have to stop whining about how costly and hard it is to turn this ship, and start working with the ONC on how to make healthcare IT better, faster, and ultimately more meaningful to all stakeholders involved in its use.

</Mandi’s Rant>

EMR Documentation Pitfalls, EMR Adoption Numbers, and from the Hospital EMR

Written by: John Lynn

A Shortcut to Wasted Time nyti.ms/QdK9Lq On the pitfalls of EMR documentation.

— Heidi Roman MD (@hkroman) November 23, 2012

This article is one of the most thoughtful pieces I’ve read about the challenges and benefits of EMR versus paper charts. It hits the nail on the head of the opportunities that are available with EMR, but also the stark realities of what’s happening with EMR implementations as well. Go read it and I think you’ll agree.

International survey shows two-thirds of US primary care docs using electronic medical records, up from 46% in ’09 ow.ly/fttKR #EMR

— Commonwealth Fund (@commonwealthfnd) November 24, 2012

I’m always suspicious of EMR adoption rates that are put out there. This one puts EMR adoption at 69%. What I think is more significant is the change in EMR adoption rate from their previous survey in 2009 where EMR adoption was at 46%. A 23% increase in EMR adoption is definitely a trend, but we didn’t need a survey to tell us that shift was happening.

Ok if one more nurse writes “please see!!!!!” in the EMR next to a stable pt who’s simply annoying I’m going to set fire to this place.

— Dr Killpatient (@Talesfromtheer) November 25, 2012

You should probably just go read all of Dr. Killpatient on Twitter. Yes, I’m sure many of you will cringe at what’s tweeted. I did in some cases too, but it is a really transparent look into one ER doc’s views. I wonder what his nurses would think of the tweet above. It’s also interesting what’s documented in the EMR. I wonder what Dr. Killpatients note looked like. Probably not as specific as the tweet.

Resistance to Change Will Fuel EHR Adoption

Written by: John Lynn

Resistance to change is the number one reason doctors aren’t adopting EHR software. Sure, doctors will often give a lot of other reasons why they’re not adopting EHR software, but in most cases those are just shields for the real reason they don’t ant to adopt EHR software: Change.

Doctors are certainly not unique in this arena. None of us like to change. I’m a creature of habit as much as the rest of us. In fact, I just tweeted yesterday that I need to change my method for writing posts. I know it’s the right thing to do and would make me more productive and probably increase the quality of my posts, but I’m resistant to changing the approach that I’m comfortable doing. Doctors are no different and let’s be clear that documenting in an EHR is different than a paper chart. An EHR implementation requires change.

While resistance to change is the current barrier to EHR adoption, I would also assert that resistance to change is going to be the reason why EHR adoption will become the norm.

I’m sure this will make some of you feel a little uneasy. What we have to realize is that most new doctors coming into the medical profession love technology and can’t imagine having to go find a paper chart. They can type faster than they can write and so they idea of writing in a paper chart would be a big change for them. These doctors are use to only reading typed material. They don’t care to learn how to read physician hieroglyphics. These new doctors don’t see carrying around a device as a burden, but as a normal part of life. Taking that device away is a change for them. They won’t want to change their digital ways in order to live in a paper chart world.

In a story I’ve often related, I saw this first hand when my medical student friend told me he hated his current rotation because they used paper charts. He then went on to say, “I hate paper charts because I can type faster than I can write. And…” The glazed over eyes was when I could see that for him he couldn’t see any justification for using a paper chart. He wasn’t quite sure how to articulate why he didn’t like paper charts, but he just inherently knew that he didn’t.

Time is the great healer. With enough time, the resistance to change will be against those who want a doctor to use a paper chart.

Large EHR Vendor Recommendation

Written by: John Lynn

One of the more interesting dynamics in the EMR and EHR world has to do with large versus small EHR companies. I guess we’ve always loved a big versus small story ever since David slew the Giant Goliath. Plus, there’s something American that causes most of us to really root for the underdog. I don’t know what it is, but unless my team is playing I’m most often hoping that the underdog spoils the party and does something surprising. Maybe this is why so many of us love to pit the big EHR vendors against the small EHR vendors.

Personally I don’t have any particular preference for or against larger or small EHR vendors. I care more about choosing the right EHR vendor for the right situation. In some cases those are small EHR vendors and in some cases those are large EHR vendors. I only discriminate against EHR vendors who don’t perform. Many of those that don’t perform I call Jabba the Hutt EHRs. If you haven’t read my Jabba the Hutt EHR posts, you should.

Although, what prompted this post was a comment I read recently from a doctor who uses a large EHR vendor. I won’t say which EHR or who made this comment since it doesn’t matter to learn from the comment. They basically made this suggestion:I recommended a large EHR so that it can connect everything. Then he said that the large EHR vendor decreased productivity.

Certainly I realize this is only one person discussing why doctors should go with a large EHR vendor, but if I’m a large EHR vendor I’d be really upset if this is my message. And while this is one example, I’ve certainly heard it other times before.

Think about this message from a physician’s perspective. I can either go with an EHR product that decreases my productivity (Translation: I make less money) or with an EHR product that can connect everything (Translation: That’s nice, but does it save me time or make me more money?)

All the connections in the world are great, but if you hurt a clinical processes business in the process then that’s going to be a real problem. I’m a huge EHR software advocate. I think every doctor should use EHR. However, if EHR vendors continue to do EHR implementations that have a long term negative impact on EHR productivity, then physicians will continue to resist EHR software in their offices.

The good news is that I’m seeing more and more EHR vendors focused on maintaining and improving the productivity of an office during and after an EHR implementation. I hope that trend continues and that all EHR vendors become fanatical at maximizing the efficiency of a practice during and post EHR implementation.

Predictions on EHR adoption in 2012

Written by: John Lynn

I mentioned that I’d be doing some predictions on EHR adoption in 2012. Well, it turns out that I did a large part of my EHR adoption predictions in my Meaningful Use 2012 Predictions post. Here’s the section on EHR adoption prediction in case you missed it:

Hospitals Capitalize – My best prediction is that hospitals will see the money flowing and be unable to resist following the money line. We’ve already largely seen this shift in hospitals IT projects. I know a number of healthcare entrepreneurs who have said that hospitals aren’t really doing any major IT projects outside of meaningful use. Hospitals will continue this trend and will likely end up taking the majority of the EHR stimulus money that’s being paid out.

Small Doctors Offices Stay Away – As I wrote about previously, most EHR incentive money is being paid to existing EHR users. In 2012 we’ll be moving past those existing EHR users and I predict that most small doctors offices will continue to sit on the sideline of EHR. The money isn’t large enough for small doctors to overcome all the work required for them to implement an EHR and the EHR penalties are a drop in the bucket for most of these doctors.

I imagine that many will be thinking, “What about the other EHR benefits beyond EHR stimulus money?” To that I’d say, you’re absolutely right. There are plenty of other benefits to having an EHR that don’t include government money for EHR. Unfortunately, the free government money has created this myopic view of the world where those other benefits have lost all their appeal.

With that as background, I personally still say that we’re probably somewhere around 25% EHR adoption. I’m talking about doctors who chart in their EHR all day every day. Certainly the number is much higher if you expand it to anyone who is charting something electronically.

My ambitious guess is that we may even reach 50% EHR adoption by the end of 2012. To me this would be a huge jump, but it seems that the momentum might just be there to make that big jump. I didn’t think this previously, but an experience yesterday at my wife’s OB/GYN has me thinking that EHR adoption may come quicker than I think. Although, it also firmed up my idea that after this wave of EHR adoption we’re going to hit a nasty wall.

A Little History
First let me tell you that my wife and I have been going to this OB/GYN for about 6 years. She’s an older physician who we love. I think that love happens after a miscarriage and two healthy babies. Being that I was working in the EMR field, every time my wife’s gone for an appointment I’ve asked this doctor what she thought of EMR. I believe in our first encounter about 5 years ago her response was something like, “I’ll never do an EMR. I’m good with my paper charts.”

With our last child (he is now 2.5 years old), I mentioned that there was some free government money for EHR. Her response stuck with my wife and I. She literally laughed one of those spontaneous can’t stop laughs and then almost to herself said, “Free money for EHR…*more laughing.”

Needless to say she wasn’t that interested in EHR or any free government money.

Yesterday’s Visit
My wife had another appointment with the OB/GYN yesterday and I decided to tag along. Yes, I mostly just wanted to poke her about EHR use again to see where she was when it comes to EHR and hear her perspectives. She came into the room and said something about not having my wife’s full chart and needing to get it out of storage. I saw the perfect opportunity and so I asked her where her EHR was. She responded, “We have an EHR.”

I was a little taken back by her response. First, because she was so anti-EHR before. Second, because she what seemed like a relatively full paper chart in her hand and was asking for the old paper chart to be pulled from storage. I then prodded some more and said, then where is your EHR? She said it was in the hall. She saw 7 patients an hour (did I hear that right?) and there’s no way she could do the EHR and keep that productivity. I then asked her when she did her charting in the EHR, after hours? She kind of nodded with those stares that mostly says, “I still haven’t figured out how I’m going to get my charting done in the EHR.”

When my wife and I were heading to leave, my wife’s doctor asked what I believe was a nurse in the office which EHR software they were using. Yes, she knew the name of the company, but this EHR company has 6-8 EHR software (I bet you can guess which one) and she didn’t know which one they had. The other lady was going to pull up the EHR so I could see, but the EHR was down. Needless to say, I knew the company and the product quite well. In fact, I have an an entire thread on EMR and EHR about this EHR company with people complaining about it.

As we were leaving, my wife’s doctor said, “I hate EHR. It makes me feel like I’m crazy.” (as she held her hands up next to her head in the universal sign for getting driven crazy) Then she pulled out the “Sucks” word as she referenced her EHR vendor.

As I say above. This story just reinforced my view that many like this anti-EHR doctor will adopt EHR in 2012, but if others experiences are anything like her experience then we’re going to hit a massive wall.

For those wondering, my wife’s appointment went well. At her next appointment I’ll have her leave my business card and see if I can do lunch with her doctor some time to get the rest of the story. I want to ask her what she thinks of Meaningful use! lol

EHR Adoption Rates, MU Stage 2 Delayed, and IE vs Chrome for EMR

Written by: John Lynn

As is now tradition. Some EMR and EHR tweets that are of interest this weekend.

@linejboise
James Lineberger
2011 EHR Adoption Rates #EHR #EMR #Health IT bit.ly/uQS7VP

They put EHR adoption at about 50%. Remember these numbers are from the CDC. I think they’re being generous. I’d still put adoption at about 25-30%

HHS extends MU Stage 2 deadline to spur faster EMR adoption | Healthcare IT News: http://www.healthcareitnews.com/news/hhs-extends-mu-stage-2-deadline-spur-faster-emr-adoption

I know I wrote about this before. Now it’s official. So, I guess there is some small advantage to showing meaningful use in 2011 instead of waiting until 2012. Although, not much.

Now a great series of tweets that discuss the bain of many IT people’s existence: IE

@chukwumaonyeije
C. Onyeije, M.D. MFM
I still can’t believe why ANYONE would use Internet Explorer (unless they were forced to by IT geeks at gunpoint…)

@faisal_q
Faisal Qureshi
@chukwumaonyeije …or EMR vendors that use the IE engine within their own app

@chukwumaonyeije
C. Onyeije, M.D. MFM
@faisal_q Funny that you should mention… I’m working with a hospital based EMR that goes NUTS in Chrome. #EMRFail …

The internet would be a lot better if IE weren’t around. Yes, I’m a huge Chrome fan myself.

The EMR and EHR Pool Party

Written by: John Lynn

I was chatting with the VP of Marketing from GE at MGMA recently and he made a good analogy. He said that the current EHR environment feels like being at a pool party. Everyone’s in their swimsuits, but they’re waiting for someone else to jump in first.

I think we’ve all been at a pool party (same thing happens on the dance floor too) where we’re waiting for someone to start, but once someone does everyone else joins in. I agree that for many the market kind of feels that way. There’s very little doubt that the HITECH Act has increased interest in EMR and EHR software. The number of people looking at and considering EMR and EHR software has got to be at an all time high. However, so far we haven’t had enough people jump in (buy and implement an EHR) so that everyone else will follow.

I’m sure we could think up a lot of reasons why this is the case. I guess many of those standing on the sides are waiting to hear from others if “the water is too cold.” This analogy goes well with my belief that the early meaningful use and EHR users are going to have a strong effect for good or bad on the next wave of EHR adoption. If those that have jumped into the proverbial EHR waters enjoy the experience and find that it’s not “too cold,” then I’m sure that many others will jump in as well. If the first to jump in jump right out or look like they’re having a miserable time, then we can expect many of the others to stay on the sidelines.

I think it’s still a little bit too early to tell how the first meaningful use EHR adopters are doing and what their message to their colleagues will be. So far most of the meaningful EHR users were those who adopted EHR long before the HITECH Act. I’m waiting to hear from those who started adopting post-HITECH Act. Then, we’ll have a better idea of how EHR adoption will progress going forward.

The Commodity EMR, EMR Adoption and Other EMR Tweets

Written by: John Lynn

Time to go through some interesting Tweets from the world of EMR and EHR.

@glevin1 – gary levin
Commodization of EMR | HealthWorks Collective

There was a link on this tweet too, but it looked like a link to a page that stole the content from the original article. I’ve been intrigued by the question of whether EMR is a commodity software or not for a while now. I still haven’t come to a firm conclusion. This article uses the idea that you can buy Allscripts MyWay at Costco as a way to say that EMR is a commodity. You can also buy eCW at Sam’s Club I believe. Although, as best I can tell, that was basically a PR move on the various EHR vendors part.

Also, the article says that Allscripts MyWay product came from the purchase of Misys. Actually, I think MyWay was originally Aprima. I believe the Misys EHR software is set to be sunset.

What do you think? Is EMR a commodity?

@BrianSMcGowan – Brian S. McGowan PhD
Percent of US PCPs using EMR = 17% in ’00′ – 28% in ’06′ – 46% in ’09′ (vs 99% in Netherlands) #socialQI #progress??

The link on this one was to a terribly long PDF file. So, I cut it out. I just wish I knew where Brian got his numbers. I call BS on the US having 46% EHR adoption in 2009. I still put us at about 25% EHR adoption now. Maybe a little higher if I’m being generous. Of course, a lot of people define EHR a lot of different ways. So, that might be part of the issue.

@DRZORBA – Zorba Paster
Back to the clinic. Everyone brings their records with them. No EMR here. If they lose their record then they’re @*%&M.

Hmm…imagine a world where the doctor didn’t keep any record. The patient was just responsible for the record. That idea is fraught with trouble and issues, but I bet many doctors would love to not have to worry about the records part of their job.

@medreccom – Medical Records
“Paper is dangerous and inefficient, it doesn’t belong in health care any longer.” Future of #EMR: on.mash.to/uhVkHn

I was interested in this tweet since it linked to an article on Mashable (a mainstream tech site). So, if I get this right, this article and series was sponsored (ie. paid for) by Lenovo and profiles Practice Fusion. In other words, Lenovo paid to advertise Practice Fusion on Mashable. Good for Practice Fusion. Although, I’m not sure how many doctors read Mashable. Maybe the article wasn’t about finding doctors, but was a way to find more tech people to come work at Practice Fusion. The article itself is pretty basic for someone that reads this site. Not a bad play if that was the intent. Full Disclosure: Practice Fusion advertises on this site. Although, they certainly didn’t pay me to write about this and link to it.

EMR Market Topped $20B Last Year

The False Economies of EMR

EMR Documentation Pitfalls, EMR Adoption Numbers, and from the Hospital EMR

Resistance to Change Will Fuel EHR Adoption

Large EHR Vendor Recommendation

Predictions on EHR adoption in 2012

EHR Adoption Rates, MU Stage 2 Delayed, and IE vs Chrome for EMR

The EMR and EHR Pool Party

The Commodity EMR, EMR Adoption and Other EMR Tweets

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