Ten plus years ago, I was giving talks suggesting that at some point relatively soon the EMR was going to become a reality. In 1999, at Harris Interactive I actually got the chance to launch a study which I hoped was going to soon show a relatively steep growth in EMR use in physicians’ practices. (The study was called Computing in the Physician’s Practice). Sadly because the study wasn’t a huge financial success and because I wandered off to do other things, it was only fielded in late 1999 and early 2001.
I developed a very complex metric of what computing was used in the physicians office, and in particular what doctors actually did and planned to do electronically. So for example, did they order lab tests electronically, did they look up test results or PACS images online, did they take notes electronically, etc, etc. By the second fielding, the questionnaire changed a little and sadly Harris started asking doctors if they were using an EMR—a pretty useless question as they didn’t define what it meant.
The results at that stage weren’t too encouraging. Because new data is out today, I went back and took a look. Around 25% of physicians were looking at some individual patient data using some type of a computer back then, but only around 8% were taking any clinical notes using one (pens and micro-cassettes were the order of the day). The juicy data is on page 80 onwards of the slideshare deck. Obviously, the total percentage of doctors using an all singing-all dancing EMR was very low.
For those of you really interested in the archaeology of the EMR I’ve put the 1999 study results up on SlideShare (Yes, it was proprietary then, but I can’t imagine anyone cares much about that now!).
So nine years ago you had about a quarter of doctors who at least came within sniffing distance of something like an EMR. And that was already a low number in terms of international comparisons. The docs in the N countries (New Zealand, Netherlands and Norway) were already on their way to 100% penetration then.
Fast forward to this past Friday.
CDC (which for some reason has taken on the mantle to find out
what’s what in physician computing use) has done a study of about 1,200
docs this year—updating the one they did in 2006. Only preliminary top line data is out but it is encouraging:
In the 2008 mail survey, 38.4% of the physicians reported using
full or partial EMR systems, not including billing records, in their
office-based practices. About 20.4% reported using a system described
as minimally functional and including the following features: orders
for prescriptions, orders for tests, viewing laboratory or imaging
results, and clinical notes. Comparable figures for the 2006 NAMCS, the
latest available for the full survey, were 29.2% and 12.4%,
So now I’m going to make a giant leap and say that my 1999
data—the 28% who said that they looked at some clinical data about an
individual patient on a computer—is very roughly equivalent to
the 29% in 2006 who said that they were using a full or partial EMR
system. That suggests that not much changed between 2000 and 2006. (Yes,
I know that I don’t know the definitions in the CDC survey, but I have
asked that they respond to this post….)
So now, two years after 2006 we’ve gone from 29% to
38%—a relative leap of nearly 40% and an absolute increase of 9%. This
suggests that just maybe with the growth in all those EMR vendors like
Epic, eClinicalworks and many many more, we are now in the steep part
of the “S” curve growth.
And we have yet to come the $40 billion more to be invested that the Prez2Be has promised (OK, I’m mostly joking here….)
There’s just one problem. We’re using the wrong words and talking about the wrong thing.
While the EMR diffusion has been waiting to happen, what’s
going on out there in the wider world is a rash of different
applications being developed for physicians, patients, consumers, and
everyone else in between. What we now need to realize (to paraphrase David Kibbe writing on THCB a few weeks back) is that the EMR is not the be all and end all.
In fact the EMR doesn’t exist. Nor does the PHR, the
integrated compiled mainframe, and who knows what else. Instead, like in the
rest of the tech world there are data and there are applications.
In health care those applications are starting to form
tools that help both to record what is happening, and help to
personalize and analyze information. They next then help support
decisions and enable transactions. And those tools need data both about
general issues (e.g what’s the right treatment for these symptoms) and
specific individuals (e.g. what drugs is this person taking, and what
symptoms do they have?). Those data are increasingly coming from a
multitude of sources, and more and more are being opened up.
So the correct question is not, “are you the physician
using an EMR?” In fact the TLAs of EMR, PHR and the rest should be
The correct question is now, “how are you receiving data
about your patients, and what tools are you and they using together to
improve their care?”
I didn’t know how to ask that in 1999, but since the
growth of Health 2.0, I now do. And hopefully we’ll see the number of
physicians and patients able to answer that hit the steep part of
the “S” curve in the next two to five years.
Categories: Matthew Holt