Most Americans Don’t Yet Perceive the Benefits of EHRs

Consider all the stakeholders with something to gain by moving from paper health records to digital electronic records. Who do you think would gain the most from EHRs, and who the least? A survey from Xerox finds that the among all the groups American adults say have the least to gain through EHRs is, the most common response is…patients.

29% of people aren’t really sure who’s to gain from moving to EHRs.

To better understand Americans’ views on electronic health records (EHRs), Xerox polled 2720 adults 18 and over in May 2011.

The topline finding is that 83% of people have concerns about digital medical records.  The most concerning issue is that “my” personal health information could be hacked, cited by two-thirds of people. The second most common concern is that  digital medical record files could be lost, damaged or corrupted (noted by 54%)  and that personal health information could be misused (52%). Another worry is that a power outage or computer problem could prevent providers from accessing health information, cited by 52% of people surveyed.

Only 16% of people surveyed said they’d been involved by their health provider (hospital, doctor, dentist) in converting their paper health records into digital format. This is only 2 percentage points higher than the number of people saying they’d been involved in the digital EHR conversion process last year.

Xerox asked people their perceptions about converting paper medical records to digital format: the most common shared perspective is that digital records could lead to better, more efficient care, cited by 42% of people. “I think it’s necessary,” was asserted by 37% of people, and “I want my medical records to be digital” was noted by 29% of people. 14% of people think paper records are prone to errors.

Interestingly, among people who are familiar with the conversion of paper to digital records, the consensus on these positive aspects is greater: for example, 51% of those familiar with EHRs say digital records will mean better, more efficient care compared with 42% of the general population. 45% see the move to EHRs is “necessary,” vs. 37% of the overall population.

On the less sanguine side of EHR perceptions, 1 in 4 people believe that moving to digital health records “seems like a huge undertaking that will be riddled with problems before it works well.” 17% of people simply aren’t familiar with the conversion of paper to digital records. And 12% of people say the prospect of moving from paper to digital records “frightens me.”

Xerox created the infographic summarizing the survey’s results, shown above,

Jane’s Hot Points: This survey reveals something important about peoples’ perceptions of the value of EHRs once they become familiar with the migration from paper records to digital: that more people see positive aspects of digital health records once they become familiar with the concept compared with people who aren’t acquainted with EHRs. This strongly suggests the need for education and raising awareness of EHRs.’

A key aspect of this work will be communicating the value to the individual patient: that is, to “me.” Health is personal: it’s about the self, the family, other loved ones, and “my” community. Communicating the benefits of EHRs across these consumer group-types will be important to gain health citizens’ trust in this new (for most people) form of health information. That will be a strategic, necessary step that will help providers get to meaningful use.

While Xerox suggests in its press release that it’s providers who can serve up this sort of education, the Federal government, through ONC and the leadership of Lygeia Ricciardi, is developing just such a campaign: Putting the “I” into Health IT. I am part of a working group informing the consumer message component of this program, and it’s moving along. quickly. Expect to see the launch of this important campaign in the autumn 2011. In the meantime, you can get a flavor for this effort by watching this excellent video.

Jane Sarasohn-Kahn is a health economist and management consultant that serves clients at the intersection of health and technology. Jane’s lens on health is best-defined by the World Health Organization: health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. She blogs at HEALTHPopuli.

26 replies »

  1. HITECH Junkie, We haven’t sought ONC certification at this point. It costs far too much for a startup, and we really don’t need it.

    I am told by many so-called authorities that even though an EMR system is certified, that doesn’t mean they currently meet most MU Stage 1 requirements. And apparently, most can’t.

    However, if a doctor embraces our MedKaz® System in conjunction with their EMR system (or in fact with their paper charts), he/she can meet 80% of MU Stage 1 requirements from day one!

  2. I understand the reluctance of doctors (and hospitals) to adopt EMR/EHR technology. It’s expensive and requires a significant learning curve for a questionable benefit. However, let’s look at the reality of the situation. Medicare reimbursement WILL be reduced, starting in 2015, for doctors and hospitals who are NOT “meaningful Users” of certified EMR/EHR technology. That’s the law. If you want to treat Medicare patients and receive yor full reimbursement, you’ll need to hop on the bandwagon.

    If you want to treat Medicare patients and receive your full reimbursement, you might as well hop on the bandwagon NOW so that you can get the full amount of the incentive. I’d rather get $44k for buying and using a crappy system than get nothing for buying and using a crappy system, or not buying and using a crappy system then losing even more because my reimbusement is reduced.

    Last but not least, the reductions will be cumulative – the e-prescribing penalty and the EMR penalty will “pile on”.

    Love it or hate it, it’s here to stay. hey MedKaz, is your free EMR-lite certified?

  3. Richard, I have to disagree. I have no doubt it will happen, but only when a new generation of electronic record systems is developed that really work for doctors.

    They have to be easy to use, cheap, and provide the information you need to deliver quality care and coordinate your patient’s care.

    There’s no good reason such systems aren’t available now. As I posted above, our focus on Internet-connectivity has blinded us to alternative approaches that make far better sense. Our free Patient Record Manager component in our MedKaz System is a very simple, easy to use EMR-lite that could presage a new generation of highly functional systems.

  4. Here is my view on this “fiendishly complicated’ subject.

    For five years, in countless blogs, and in two books – Obama, Doctors, and Health Reform (2009) and Health Reform Maze (2011, now at printers), I’ve been saying digital medical records are a dud.

    This does not mean I’m a technology Luddite, or a conservative physician who resists Obamacare in all of its manifestations. It means I’m a realist. For multiple reasons, EHRs simply don’t work for hospitals or doctors. For most physicians, in their present form, EHRs are impractical, unworkable, disruptive, and overly expensive without any tangible return on investment.

    EHRs might work if government totally subsidized them without unrealistic “meaningful,” i.e., bureaucratic, conditions, or if EHR vendors offered them for “free” with advertisers footing the bill. But only then would they work if EHRs were useful and user-friendly.

    One problem, as I see it, is theological. EHR enthusiasts see digital data in quasi-religious terms, as some sort of government electronic magic wand or Holy Grail that will transform health care into a more perfect, more tractable, more traceable system.

    It ain’t going to happen. I’m reminded of a country song I used to hear as a youth in Tennessee, “Mother’s not dead. She’s only sleeping, patiently waiting for Jesus to come.” It’s going to be a long wait, as Sally Pipes explains below.


  5. Merle, I suspect we are probably in violent agreement.
    Since I understand exactly what you are saying, and agree with most of it, I will assume responsibility for not expressing my thoughts in a clear enough manner. I will try to do better in the future.

  6. Margalit, I do feel a great sense of urgency to improve care quality and reduce its cost so, to that extent, I disagree with you. I want to move as fast as we can. While we dawdle, people are dying and suffering unnecessarily, and we’re wasting staggering sums of money. To me, that’s inexcusable. I’m also as market-oriented as you probably think I am. I look to private enterprise, not government, to meet our healthcare IT needs.

    I have friends who have serious illnesses and are desperate for help. Their doctors make mistakes, order duplicate or unnecessary tests, don’t coordinate their care, and keep asking the same annoying questions – not because they don’t care but because they don’t have access to the patient’s complete medical record from all their providers. It’s not the doctors’ fault. They do the best they can but the so-called system we have today doesn’t work for them or us.

    In my opinion, we’re not making progress because we’re defining the problem incorrectly. The problem isn’t how to make a patient’s records available over the Internet.

    The problem is two-fold and requires separate, independent solutions. One is how doctors should keep records. The other is how to make a patient’s records available to their care providers when and where they need them.

    There is no question in my mind that every doctor should have an electronic record system and the sooner the better! It can make them more productive, help them provide better care, and reduce their record-keeping costs. But most electronic systems available today don’t. They’re too hard to learn, too hard to use, have too many features doctors don’t want, are too expensive to install and too expensive to maintain. They simply do not meet the needs of most doctors or hospitals.

    How do we solve this problem? Not by having government force doctors and hospitals to adopt these systems. We need to encourage the development of new systems that actually help and benefit them. If we build the right systems, most doctors I have spoken with will happily embrace them and will be able to provide better care. And the companies that build them will deserve the financial rewards they generate.

    The other problem is making a patient’s records available to care providers. From everything I’ve seen and read, the correct solution is not to store them on web servers and make them available over the Internet. According to every poll and survey, that’s not what consumers want. So let’s stop ignoring them.

    As you know, we’ve been working for several years to solve this second problem, and I think we have the right solution. We’ve developed a unique, patient-focused system that we believe meets the needs of doctors and patients. I’m not trying to promote it here (if you are interested in its specifics, visit our web site, medkaz.com). I’m merely trying to demonstrate that by correctly defining the problem of healthcare IT, we can come up with better solutions than are being offered now, and to argue that we should do all we can to foster their development.

    Regrettably, as the expression goes: “the train has left the station.” Our government is spending billions of dollars in incentives to encourage doctors and hospitals to adopt the systems that don’t work for most of them. We’re not about to derail this HITECH stimulus program now. But we can do everything possible to innovate and come up with better solutions to the two problems we face.

  7. Merle, I don’t think Xerox is the “bad guys”, and I don’t know what makes you think that I said that. They do what any company does – marketing to encourage business growth. It should be our choice to buy the product or not.

    I don’t see how we win if they win, and vice versa. However, reading your response to MD as HELL, I understand that you support the “urgency” in implementing EHRs, and that is probably where this misunderstanding is rooted.
    I believe EHR and HIT in general is largely a positive thing and definitely the way things should be. I take issue with the “urgency” and the mad rush to widespread implementation. I also take issue with the government quoting obviously biased vendor surveys and particularly vendor self-serving conclusions, in order to create this sense of “urgency”.

    I believe the market should dictate the rate at which products are sold and I don’t think the government should be in the business of changing consumer perceptions in order to encourage a particular course of market development.
    If you don’t see the problem here, then perhaps you are not as market oriented as I thought you were, and perhaps I am a bit less of a “Socialist” than you assumed I was 🙂

  8. MD as HELL, I’m sure you believe that but I think we can show you that a properly designed patient-focused personal health record can really benefit both you and your patients.

    Before you ask, yes, we make money — and so do you! Want to participate in our pilot study to learn how a system can meet everyone’s needs and everybody wins?

  9. Margalit, you lost me. Xerox isn’t spending taxpayer money on their marketing campaign. Why are you complaining about them, painting them as the bad guys, and challenging their motives? If they win, we taxpayers win.
    If they lose, we don’t! Put another way, they are taking the risks and if they win everyone wins. Is that bad?

    Seems to me that your gripe is with HHS. Jane says “the Federal government, through ONC and the leadership of Lygeia Ricciardi, is developing just such a campaign (similar I guess to what private companies are doing): Putting the “I” into Health IT.” I don’t know who took the first step but it must have been the government since the HHS-sponsored committee apparently was formed long before Xerox commissioned its market study.

  10. I am very happy to let the entire world win.

    I am not very happy to spend tax payers money on a marketing campaign to alter Americans perceptions of EHRs, perceptions which are perfectly sensible by the way, just so that those who sell, maintain, implement and otherwise make money from the EHR push, make a little more money, faster.

    That better patient-provider communication that seems so “urgent” is not about health care, Merle. Here is what Xerox says:
    “Providers need to start conveying the benefits of electronic records, particularly the security advantages over today’s paper-based system.”

    Really?? Why?

  11. rbaer, a little bird tells me you visited our website, medkaz.com, so you know the wonderful solution you wish for is well on its way! 🙂

    As you intimate, building a complex system that can do all these things is hard — no one has done it. It would have been easy to build a hard-to-use system, but no one would use it (that may be why existing PHR systems, including Google Health, have not been adopted by either patients or doctors). Building one that is easy to use has been very hard and has taken far longer than I expected. But that’s ancient history.

    We’re about to launch a pilot study to prove its efficacy. If you or any other docs, especially PCPs who keep paper records, would like to participate, we’d love to have you. Contact me through our web site.

    Margalit, the Xerox spokesman said: ” the survey results indicate an urgent need for better patient-provider communication.” I suspect everyone reading this blog will agree. Don’t you? The original poster, Jane Sarasohn-Kahn, certainly does and apparently so does HHS.

    Why does it bother you that a for-profit company is actually offering products and/or services that might alleviate some of the serious problems with our healthcare system? They have been smart enough to identify a problem and needs that aren’t being met, and formulate a solution. They are even sharing the results of a market study they paid for which you, I or others might use to sharpen the focus of our products and services. If they are right, aren’t we all better off?

    Why can’t there be win-win solutions in healthcare? Would you rather wait for government, using your taxpayer dollars, to try to develop a solution? I’m very happy to let them win as long as the public wins! Aren’t you?

  12. Merle, I don’t understand what you don’t understand 🙂

    Xerox is surveying the market, as it should, and publicizing the results as it should, and trying to influence public opinion as it should, and drum up business in the process as it also should.

    As educated readers, we should take it with a grain of salt when a business states that it is “urgent” to change consumer perceptions in a direction that benefits their business.
    It may be “urgent” for Xerox, but I don’t see any “urgency” to the tax-payers.

  13. Alas, but how would we ever do that, Mr Bushkin? If there was a system that puts the patient at the center of their care, so that they control their records and who sees them, so that they participate in their wellness and care decisions; a system that puts their lifetime medical record in the hands of their care providers—when and where they need them, and that accepts records in all formats, from all sources, and overcomes medical-record incompatibility and confusion, and that is secure, easy to use, convenient, affordable.
    But such a system does not exist anywhere … too sad.

  14. Margalit, I apologize if I misunderstood your point and suggested that your concern was about Xerox or its subs overcharging or in some other way taking advantage of care providers.

    Having said that and both read the Survey report (for a second time) and visited Xerox’s ACS subsidiary web site, I confess I don’t understand your point.

    Xerox provides their services to many industries and they are doing what you, I or any intelligent business person would do were we in their shoes: they are trying to understand the healthcare market so they can be more effective at serving it. And they are publicizing what they learned presumably to let people know they have an interest in healthcare and to share their findings.

    From what I can tell, they don’t deal directly with patients, they cannot influence the consumption of medical services, and they have a great many competitors who will force them to improve quality and sell at competitive prices. What damage or harm do you think they can do? Can they bribe or otherwise cause doctors to tilt a patient’s care toward their products and away from competing products? Can deals with providers to use Xerox products or services translate into higher healthcare costs? I think the answer to both is no. So where’s the beef?

  15. Merle, please read the article linked with the word “survey” in the original post.

    I did not use the term “gouging”.

    When someone is poised to financially benefit from doing something, and that someone is recommending that people be encouraged to support doing that something, the motives for such recommendation are usually questioned, at least when it comes to doctors:
    When doctors order an MRI and they happen to own an imaging center, everybody is up in arms. Why are you not up in arms when Xerox is recommending implementing EHRs while they also happen to own an EHR implementation business?

  16. Margalit, paranoia is getting the better of you! I don’t have a clue what Xerox’s interest is in healthcare but do you really think they are out to gouge patients or care providers?

    I suspect their interest is in offering paper processing services and products like scanning, printing and copiers to healthcare providers — like they do to other businesses. If that’s the case, irrespective of their motives, whether altruistic or sinister, there is little chance they can gouge anybody. Similarly, if they are involved in helping providers convert to and adopt EMRs, they have many competitors.

    The markets for these products and services are highly competitive and, unlike in healthcare, clients and customers can easily compare quality, performance and price. In short, competition will ensure that their customers get value.

  17. An educational campaign to acquaint consumers about PHRs and EMRs doesn’t overcome the fact that their fears are well founded.

    Internet-accessible records are hacked into every day with increasing frequency and we can’t stop that. Digital records can and will be lost, damaged, or corrupted. Personal health information can and will be misused. Power outages, computer problems and natural disasters will happen.

    Thus, the solution must not be to ignore the problem. It must be either to solve it, or avoid it. We know we can’t solve it so we should avoid it — and that’s easy to do.

    All we have to do is stop insisting that a patient’s care provider records must be accessible via the Internet. Instead, give copies to the patient and let the patient give them to their care providers when they seek care.

  18. Quack,

    as Dr. Mike says, there is benefit in large integrated systems, as I learned myself (during residency training at a tertiary center and practicing in a large (900 providers) MSG. To really work for solo or small group practitioners, they would need to be linked that you could access all data for a patient at once (not with a series of digging and clicking like some “linked” EHR offer at present). But one has also to state that the benefit comes at a steep price/investment.

  19. Sorry to be contrarian… (but then again this group should be used to it)

    Should a patient (American or otherwise) even care about, much less perceive the benefits of an EHR? The patient cares about their health (sometimes 🙂 ) and may be some actionable information that will help them improve it (again sometimes 🙂 )… when and why would they stop to think about the benefits of an EHR?

  20. It is not possible to educate a patient about the value of an EHR to them unless you are prepared to lie, which obviously the majority of non-users seem prepared to do without even so much as blinking. There is the potential for value, great value actually, but I would have to ask you to come back from la la land if you think that value exists now. There is some value to the user, especially in large integrated systems, but that has yet to translate into any real value for the patient. ANY intervention designed to improve the effectiveness of a system at treating any given single condition will prove effective, and hence the “proof” for EHR value to the patient rests almost completely in studies that would have had the same or better outcome had the researchers been limited to paper charts.

  21. …and what is Xerox interest in this subject? I understand they are engaged in EMR implementations and profiting from the transition from paper to electronic records.
    When physicians order MRIs, everybody wants to know how they profit from “excessive” tests. Every physician recommendation that is somewhat tied to even the measliest payment to doctors is being questioned with the obvious implication that doctors place profits above patient interests.
    Shouldn’t we question Xerox, and others, recommendations to digitize records in the same manner?

  22. You’re a doctor. Therefore, your opinion is worthless in this discussion. Just write the check and shut up.

  23. I’ve been practicing with an EMR for a year now, and I don’t yet perceive any benefit from them.