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Even with Incentives, Docs May Forgo EHR Adoption

Yes, hospitals will adopt and meet meaningful use requirements as the future CMS penalties will simply be too painful to do otherwise.  Private practices, however, may just forgo adoption and decide to not serve CMS (Medicare/Medicaid) patients.  It remains to be seen what direction this will take but as I stated in a recent keynote at the PatientKeeper User Conference, the focus of EHRs and their successful deployment, adoption and use needs to be based on what is the value that is delivered to the end user, the physician/clinician.  For too long and even today, all the grand talk of EHRs and adoption thereof focuses on the broader public good.  Yes, there will be a broader public good but if we don’t get back to focusing on delivering true, meaningful value to the end user all this talk, incentives and promotion will fall on deaf ears and many a tax dollar will be wasted.

As an aside, we have stated before on this site, the consumer/citizen may play an important role in the future.  As the first comment in response to this Boston Globe article this week puts it, he/she would not go to a doctor that did not have an EHR in place.  This is something that the digital natives of this nation who are beginning to get married and settle down with families of their own will increasingly demand. EHR adoption will come, the question is how fast and what will be the forcing functions.  Right now, just not convinced that HITECH Act $$$ will do it at the practice level.

And just by way of example regarding those youthful digital natives, my 25yr old son found both his doctor and dentist via the online user community Yelp. He’s quite happy with both.

John Moore is an IT Analyst at Chilmark Research, where this post was first published.

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6 replies »

  1. “Practices get paid by throughput, how many patients are seen in a given day…”
    That’s right! EMR’s don’t address increasing the throughput. But, on the other hand, if a physician can see a patient quickly, write almost nothing down, do almost nothing for the patient and it is very hard to beat that efficiency. It says nothing about the quality of care they deliver. If that physician really was verifying meds on every visit, really did check for drug-drug interactions, really did measure statistics how he was doing so that he could improve his quality, then I’m sure the point on efficiency would get much closer to favoring the use of an EMR.
    There need to be more studies to show that implementing an EMR improves patient outcomes if used properly, but reading the scribbles in the paper charts I see, I have a hard time believing EMR’s wouldn’t help significantly.
    So, your comparing apples to oranges. It’s true that Docs don’t want to adopt because it decreases there efficiency which affects their wallet. But the problem is that we need to value quality over throughput.

  2. Dear John,
    What a great summary and it so aligned with what I always evangelize our market, don’t talk about tools, but bring solutions that generate instant value.
    As long as there is no value creation there won’t be adoption of EHRs.
    Creating financial incentives without solving the productivity dilemma is no long term option. Even when digital natives become families, there won’t be adoption, unless patients privately pay for there services.
    Perhaps context aware systems and a deeper integration of diagnostical tools into to the clinical information and decision workflow can influence productivity, but it still won’t drive adoption if the value is not visible.
    There are good recent examples of technology adoption :
    Shared electronic records platforms, such as patientslikeme, have reached a respectable level of adoption. The value that patientslikeme offers to patients which are suffering from chronic diseases such as ALS or parkinson is high enough to keep those patients motivated to manually enter data. Did I just say no integration and manually entering data? It seems that patientslikeme creates nearly instant value. In this case the lack of integration does not seem to correlate with the grade of adoption.
    A second example relates to the implementation of smart card based healthcards. As you probably know Europe’s healthcare systems embraced the implementation of smart card based healthcards, which in a second phase should be connected to de-central EHRs. The German health IT
    industry heavily invested (300 Mio. Euro) trying to implement the healthcard based system into the healthcare system. Discussions around liability, standards, security and even a missing picture stopped
    adoption. There has never been a big roll-out, and the future doesn’t look bright. The value discussion was always on a system level.
    Last year we started implementing a smart card in our Swiss market. Creating quick value for both patients and health service providers was our biggest focus when we started our first project. We did not want to jumpstart and discuss clinical data sharing, but never forgot the big picture and started small. Our main goal was to identify how healthcare providers could benefit on an administrative level, and at the same time generate patient value. We did not focus on the clinical
    data set but we designed the architecture in such a way, that extending towards clinical information sharing would only be a small technical step. In an outside-in calculation we could demonstrate that a full implementation of phase 1 could lead to savings of 80 Swiss Francs a case (average case cost 9500 CHF). To create value for the patient we copied and adopted the self-service concept of the aviation industry allowing patients to access administrative case related information and perform transactions such as pre-check-in, check-in and payments. Once in place we can extend these scenarios to give access to clinical data, but we explicitly did not focus on clinical data.
    EHRs are just concepts and tools, but they do not create value for the people who use it. Adoption comes when you integrate EHRs into processes, automate, re-engineer and create value.

  3. The problem with the current EHR situatuion is that we will all have different software programs that don’t have the capacity to communicate with eachother. So nothing will improve, there will be no ease of data collection. Doctors costs will be higher and there visits less personal. Instead of offering an incentive carrot, the government should spend 1/10 of the money and develop a GREAT EHR system and then give it to doctors for free!! Then there is one system we all use. Everybody wins and the government doesn’t waste a bunch of money on a plan that is great in theory but ineffectual in reality. So sad that our government is sooooo incompetent at creating solutions.

  4. Hi johnnie at Chilmark,
    Best advice Do not buy, Do not buy, Do not buy, Do not buy, Do not buy.

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