We continue to see progress in improving the nation’s health care system, and a key tool to helping achieve that goal is the increased use of electronic health records by the nation’s doctors, hospitals, and other health care providers. These electronic tools serve as the infrastructure to implementing reforms that improve care – many of which are part of the Affordable Care Act.
Doctors and hospitals are using these tools to reduce mistakes and hospital readmissions, provide patients with more information that enable them to stay healthy, and allow for rewarding health care providers for delivering quality, not quantity, of care.
The adoption of those tools is reflected today in a release from the Centers for Disease Control and Prevention’s National Center for Health Statistics which provides a view of the Medicare and Medicaid EHR Incentive Program and indicates the program is healthy and growing steadily.
The 2013 data from the annual National Ambulatory Medical Care Survey are encouraging:
- Nearly 80% of office-based physicians used some type of electronic health record system, an increase of 60 percentage points since 2001 and nearly double the percent in 2008 (42%), the year before the Health Information Technology and Economic and Clinical Health Act passed as part of the Recovery Act in 2009.
- About half of office-based physicians surveyed said they use a system that qualifies as a “basic system,” up from just 11% in 2006.
- Almost 70% of office-based physicians noted their intent to participate in the EHR incentive program.
Figure 1. Percentage of office-based physicians with EHR systems: United States, 2001-2013
The report also noted that 13% of physicians who responded said they both intended to participate in the incentive program and had a system that could support 14 of the Meaningful Use Stage 2 “core set of objectives,” ahead of target dates. This survey was performed in early 2013 – before 2014 certified products were even available.
The deadline to begin attesting for Meaningful Use Stage 2 is October 2014 for the earliest adopters of Meaningful Use Stage 1, so more than one in ten physicians decided on their own to participate Meaningful Use Stage 2 capabilities more than a year earlier than necessary. These are early adopters who recognize the benefits of EHRs.
“From 2010 through 2013, physician adoption of 7 of the 17 capabilities required for Stage 2 core objectives for meaningful use increased significantly,” according to National Center for Health Statistics health-policy researcher and lead author Chun-Ju Hsiao, PhD. Electronic prescribing through an EHR and adverse drug event/contraindication alerts had the largest increase among the stage 2 capabilities, Hsiao wrote.
In 2013, Meaningful Use related functionalities with the highest adoption rates included capabilities for recording key patient health information and functionalities related to medication management and safety. About three-quarters or more of physicians had these types of computerized capabilities.
Notably, physician respondents to another national survey also noted the clinical benefits in using EHRs, including that they helped physicians access records remotely (81%), and alerted providers of a critical lab value (62%). Most importantly, 78% of respondents said that EHRs “overall, enhanced patient care”.
Overall, we are encouraged to see that physician adoption of EHRs meeting Meaningful Use Stage 2 is increasing significantly and that physicians are recognizing the value of EHRs in the care setting. The report does also tell us there is more to do and we agree. Fewer than one in three respondents (30%) said their EHR facilitated a communication with a patient via e-mail/secure instant messaging.
At ONC we look forward to continuing to work on key issues such as usability and improving functionalities so we can all see the promise of EHRs and health IT to improve care and eventually health.
Figure 2: Percent of physicians with selected computerized capabilities related to Meaningful Use objectives, 2013
Data Source: CDC/NCHS, National Ambulatory Medical Care Survey, Electronic Health Record Survey. Notes: VDT is “view online, download or transmit”. Data represent non-federal office-based physicians providing direct patient care in the 50 states and the District of Columbia, excluding radiologists, anesthesiologists, and pathologists.
Karen DeSalvo, MD, MPH, MSc. is the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services. More information about the Office of the National Coordinator for Health IT and health information technology can be found at www.HealthIT.gov
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Yes, the EHR incentive program is “on track”. Yet, this doesn’t really mean much.
Computerizing something doesn’t magically fix it.
Giving more info to patients should be a good thing, but then the patients have to actually care about the information and do something with it…this is where the real challenge comes in.
Also, for those who thing MU helps usability…where does this come from?
Ask any end user and they’ll complain about how many times they have to click is different areas just to get one MU “counter”.
what is PracticeFusion and pharmas doing together? Have you seen their recent press release. http://www.forbes.com/sites/kashmirhill/2013/10/24/practice-fusion-reviews-whoops/
My response to this post: http://www.emrandhipaa.com/emr-and-hipaa/2014/01/22/meaningful-use-program-a-success-depending-on-how-you-measure-success/
Needless to say, we all measure success very differently.
Thanks. Great comment.
Agreed that policy wonks often focus on the wrong things, though depending on where that wonk sits in the political system they are probably legally bound to base what they focus on on public input, as somebody mentioned earlier in this thread. This really does seem to be the least understood aspect of the American political system- legislators are the only ones who get to just make stuff up. Regulators have highly defined rules for public comment and rule-making within the parameters of a given piece of legislation.
Aside from civics class- I’d say us physicians also pay little more than lip service to this idea of prevention and the creation of healthier communities. Usually that means I want to be reimbursed for counseling on weight loss and exercise, not I think you shouldn’t pay me for that at all and instead should fund easy access to fresh produce and safe environments for everyone to get outside.
We especially don’t like any suggestions that such outreach and services would take place without a physician in charge. God forbid for example we use midwives in a community prenatal and birthing model the way countries with the lowest maternal mortality and morbidity rates do. As if we are taught anything about building a healthy community in medical school beyond hearing the sad statistics, or at best doing a one year fast track MPH.
See http://tinyurl.com/l6vsxly
“Given the recent Robert Wood Johnson Foundation report (Time to Act: —), it appears that the best way to reduce the cost of healthcare is not to invest in HIT but to invest in our communities so as to prevent disease before it happens.”
In other words- our prioritization of investing in physicians, their institutions, and the whole medical model is also misguided. Or do we not like that uncomfortable reading of the data?
These entrepeneurial programs are a direct result of the government’s ill conceived rules and laws to control costs: http://www.nytimes.com/2014/01/19/health/patients-costs-skyrocket-specialists-incomes-soar.html?_r=0
Gee whiz, do ya think that doctors are willing to be data clerks and clickers and do windows for the likes of J . Faulkner and N. Patterson, who have sold poorly usable medical devices endorsed by the likes of K. DeSalvo, F. Mostashvitz, and K. Sebelius, under the guise of Meaningful Use?
The programme of HITECH and the embellishments of ONC are ill conceived and cloaked with vendor financial influence, and undoubtedly will have formidable unintended consequences.
url correction, I think.
Try this to see commercial uses of feral, escaped, medical data:
To see the commercial uses of escaped medical data read the registration statement–Form S-1–of IMS Health Holdings,Inc. filed with the SEC, Jan. 2, 2014: http://www.sec.gov/Archives/Edgar/data/1595262/000119312514000659/d628679ds1.htm
Once digital always public.
Zero evidence that EHRs improve quality, outcomes, or costs.
If quality includes intreating with patients, it is deteriorating. Doctors and nurses now interact with EHR tools while patients lay in neglect.
Peter1,
You will note that I never advocated not having computers, but merely well designed software.
“Physicians don’t like anything they can’t pass off to someone else.”
Written like a nurse manager. And as usual, your charm shines through.
Wife is nurse manager, but has to learn Epic to be launched April. Docs are helping to design it. When she was at Presence Hospital in Chicago the admitting nurse liked it. Physicians don’t like anything they can’t pass off to someone else.
I don’t know how any hospital would be able to operate without a computer. Maybe you should start Luddite Hospital.
TO THE EDITOR:
Re “A Busy Doctor’s Right Hand” (Jan. 14): I wholeheartedly agree that scribes could alleviate physician dissatisfaction and let physicians do “the work they went into medicine for in the first place.” But scribes are an expensive and misguided 20th-century solution to a 21st-century problem. The fact that there is such a market for them shows that systems have not been tested adequately for usability.
Electronic health records in their current form are not designed for the workflow of the end user, the physician. Instead of creating a new work force of scribes, health technology vendors should design interfaces that are easy to use and reduce cognitive demands on physicians.
Edward R. Melnick, M.D.
New Haven
__
“health technology vendors should design interfaces that are easy to use and reduce cognitive demands on physicians.”
Well, yeah. That IS what is needed. Everyone knows that. But, a huge part of the problem is the paradigmatic 15 minute office visit. Entering, editing, or just traversing hundreds of data elements comprising FH, SH, PMH, CC, HPI, vitals, active meds list, active problems list, labs, referral reports, ROS etc — all leading to an effective SOAP and accurate coding.
It’s just too much. Productivity treadmill / assembly line medicine.
I think docs should be paid like lawyers, hourly. And paid well, like lawyers — the good docs. When I did the Guardianship I needed on my now-late dementia-addled dad, the attorney was $300/hr (that’s cheap any more). However long it took to assessment the estate financial health and devise an effective “plan,” well, that’s what it took. The whole thing cost me about 4 grand. Had to have it.
Peter1:
To imply that it’s impossible to get a discharge summary promptly without an EHR and MU is just total baloney, and just goes to show how the boosters are clutching at straws.
And how would you like to be a patient of that doc who apparently schedules them every 10-12 minutes?!
You have your resources and stats, P#1, and I have mine.
Let readers decide by researching all the info on their own who is honestly fighting for people who are struggling, and who is just putting on a show for votes each election year.
here is my last reply on this matter,
http://www.wbal.com/article/104941/12/violent-crime-in-baltimore-city-is-acceptable-what
It is what the Police Commissioner said last week, as readers can google “Baltimore City Commissioner and acceptance of murder & Baltimore Sun & 2014” and read more, just for here alone, a bastion of Democrat RULE for 50 years plus now.
Yeah, I am glad I am not in Mississippi, but I bet the Republican leadership there is a bit honest about what they will and won’t do; the Democrats, who by the way were AGAINST desegregation in the South up into the mid 1960s, well, they have suppressed that lie for decades longer, eh? Why did they quit that attitude, or perhaps the better question is, how did they reframe it and get the black vote?
The African American culture is so much improved with Barack Obama in office for 5 years now, eh? Those unemployment numbers alone for males are inspiring, true, P#1?
George Carlin said it best before he died, “the real rulers of this country don’t want an educated, informed public.” And all you apologists and defenders of said rulers continue the spin machine.
And the general public sucks it up!
@kdesalvo
Hello Karen:
What are your thoughts about the multi million dollar industry for EHR scribes needed because the EHR tools are poorly usable?
http://www.nytimes.com/2014/01/21/health/an-outdated-solution.html?emc=edit_tnt_20140120&tntemail0=y
Is your wife a Physician?
How she likes Epic depends on what she does. If she is an Administrator, she will love it. If she is in the billing department she will love it.
If she has to enter data into it – not so much.
As Bobby Gladd says most physicians don’t like it and find that it increases their workload and slows them down.
EPIC is much unloved in many quarters. Their CEO is on the ONC Health IT Policy Committee, a glaring conflict of interest to many. The Meaningful Use initiative is seen by some as The Judy Faulkner Corporate Welfare Act.
http://www.forbes.com/sites/zinamoukheiber/2013/05/15/a-chat-with-epic-systems-ceo-judy-faulkner/
Legacy, Is it buyer beware?
Is this better/different?
http://www.epic.com/about-index.php
“How we’re different:
Epic’s on-time, on-budget track record is one of the best in healthcare, as rated by independent reviewers. Epic software is quick to implement, easy to use and highly interoperable through industry standards. Information is shared securely in two ways: Care Everywhere, where the doctor controls the flow of data across organizations, and the Lucy PHR, where patients control their own health information.”
“Why we’re different:
Founded in 1979, Epic is private and employee-owned. We develop, install and support all our applications in-house. Epic’s leadership team includes clinicians, developers and process experts – people deeply experienced in patient care and healthcare technology.”
Being installed at my wife’s hospital. I can let you know what she thinks.
@kdesalvo
*******delivering quality, not quantity, of care******
Has she not read about using the EHR tools to construct 7 page progress notes? Has she not read notes of dermatologists’ cardiac exams, constructed to bill the max? just wonderin
Whatsen, I am not an IT geek, nor am I shilling for any Health IT vendors. I am an experienced data analyst, foremost.
When I worked for the REC, I routinely called bullshit on the stupid stuff at every turn (much to the irritation of my then- REC Executive Director, who berated me openly in the company for my blog and “exceeding your scope.” [bleep] her; I just kept right on). My interests are in process improvement, and obviously clinical outcomes improvement.
http://tinyurl.com/9ombbgs
I hope to get some face time with Dr. DeSalvo this week at the ONC conference in DC to probe her on some of these issues. I am going there on my own dime. I take no funding from anyone, and my blog is strictly independent and not-for-profit.
I AM in fact biased in favor of appropriate information technology, in any field.
But, see my “Clinic Monkey” spoof site and ask, “is this guy a HIT Kool-Aid Drinker”?
Seriously?
Let’s hear from K. DeSalvo on the evidence backing up her statements. Mr. Gladd, I am glad to read what you say, but you seem highly committed, almost biased.
Peter1 says:
“Legacy, are you saying there is really NO advantage and we would be better off using the phone and the mail – other technologies which needed implementation over time?”
No. I believe a well designed EMR can be helpful to patients and physicians. However, EMRs are designed for the benefit of the Government, Hospitals, Billing Departments, etc. NOT for the benefit of patients or physicians.
The best example of physicians hunger for GOOD electronic medical records is what happened recently at the U of Oregon. The residents, frustrated by the cumbersome, user unfriendly, EMR chosen by the hospital system put together their own EMR based on a spreadsheet and posted it on Google Groups.
Of course everyone was aghast at all the HIPAA violations this entailed but think about what it really meant:
1) Physicians (residents in this case) want an electronic medical record and will embrace one that is useful and reasonably easy to use.
2) The hospital EMR (approved by the government and insurance companies) was so bad, they felt it necessary to create their own instead.
I think that incident says more about the usefulness of EMRs to physicians and patients than anything that comes from Karen DeSalvo or any of the other apologists for EMR that post on this blog.
“Are not “electronic tools” medical devices as device by the F D and C Act?”
__
No.
@Peter1 says:
“…people don’t insist enough that the technology work for the user and not visa/versa, and that too many software venders mislead buyers . Since Bobby Gladd is a vender [sic] maybe he can expand on that.”
__
I’ll have my Director of Marketing get back to you.
http://ClinicMonkey.blogspot.com
😉
http://www.healthit.gov/buzz-blog/ehr-case-studies/meaningful-ehr-ehr-preventing-hospital-readmissions/
“All of the above would not have been possible without the Riverdale Family Practice’s commitment to its electronic health record system.”
“little to do with the benefits of EMRs to patients and physicians”
Legacy, are you saying there is really NO advantage and we would be better off using the phone and the mail – other technologies which needed implementation over time?
I agree though that people don’t insist enough that the technology work for the user and not visa/versa, and that too many software venders mislead buyers . Since Bobby Gladd is a vender maybe he can expand on that.
“These electronic tools serve as the infrastructure to implementing reforms that improve care”_DeSalvo
I am not aware of any data showing improved outcomes or reduced costs from HIT. Are not “electronic tools” medical devices as device by the F D and C Act?
Delete my post if you feel that’s indicated.
I’ll just point out that there was nothing personal or ad hominem in it, only a blunt critique of the quality of thought and analysis in the original post.
@karen_desalvo
Please explain why these instruments of care have been promoted and sold for more than a decade and have not undergone FDA approval as being safe and effective, let alone usable?
And now, you put out the SAFER Guidelines, which ignored the recommendations of the IOM. Why was the IOM ignored?
Amen to Legacy.
Nice touch with listing patients and doctors at #’s 48 and 49!
i have always been interested in how they do it, last i read was they have big subsidies and docs see less then 16 per day and make less then 200K. Not feasible in real work medicine unless you work at the VA
http://en.wikipedia.org/wiki/List_of_the_poorest_places_in_the_United_States
Peyton Manning to embarrass Seattle in 2 weeks.
Bobby,
Normally when people make statements like “it’s all there for you” they include some type of reference. You have not done so and I don’t know where “there” is. (Admittedly, if I was more dedicated or didn’t have a job and other interests I could hunt try to hunt down the information. I have better things to do with my time – like watch football)
Secondly, to say that there were many comments made by practicing physicians, doesn’t mean that any attention was paid to those comments. And if no attention is paid to comments, there is no true “input”. Its a little bit like the old western joke:
“Are you going to hang me?”
“No, first we are going to have a trial, then we will hang you”
Translation: It doesn’t matter what you say, we have decided what to do.
It is the sense of many physicians that most EMRs were designed according to the following criteria:
1) What is easiest and more profitable for the EMR company.
2) What the government wants
3) What the insurance companies want
……………….
47) What is best for the patient
48) What is easiest for the Physician to use
As many people have already pointed out, the fact that EMRs are being adopted has everything to do with the power of government, insurance and hospital bureaucracy and little to do with the benefits of EMRs to patients and physicians.
Oh, and now today, Sunday the 19th, Obama had the unmitigated gall to publicly announce that marijuana is no worse than alcohol. Um, is that the position of a President to be advocating for legalization of a mind altering substance that doesn’t get bonus points for being equilabrated with another substance that ruins the lives of about 10% of the population endlessly.
It is the lovely thinking of “two wrongs make a right”, and where will that go with Obama’s ongoing false rationalizations he continues to spontaneously decides almost every day since October last year per his management of Obamacare? And to bring it back to this post, how many more problems with EHR will be minimized or just ignored to force the policy onwards?
These politicians never thought this legislation through in practically any way, and we have to endure these apology/defender efforts just to “win” by making sure the legislation stays?
That is not leadership, but just blatant tyrannical rule.
Yes, you are absolutely correct, and that is why sites that have a lot of politics or other issues of intense debate by hyper partisan or extremist zealots should moderated. I do at mine, which is a health care site that at other similar sites have antiphysician trolls who gleefully write garbage when such other sites allow immediate gratification.
I hope the editors here think about the erosion of decency in discussions here on the net in considering moderation. I accept that as a limit on me.
No, the point of the comment was the fact that most poverty is in major cities, fairly much all run by Democrat mayors and legislatures in those cities. For 50 years in many of those cities, Baltimore one I know well.
So, who is the idiot, one who cherry picks some stats, or, what are equally facts that show a party that talks a great game, but then sacrifices those they use for votes, for decades.
Oh, and my allegiance is to the public, neither party that rule America. Thanks for illustrating the partisan agenda I know is prevalent at these blog threads.
You “moderate” post hoc, not going in. That’s what I meant, and that is indeed the case.
@Bobby-You are incorrect. We do read your comments. We do moderate. Please do not speak for us.
@Hayward-Thank you for taking the subject seriously enough to hold yourself to the high standards of decorum we appreciate.
@Granpappy: Hayward is correct. That sort of attack is uncalled for and inapppropriate. Consider yourself warned.
Your comments–and this portion of the thread–will be deleted shortly.
I wonder about the EHR. Without a standardized vocabulary and maybe even an OS, can it live up to its interoperability promises? Does it actually carry as much information? …cf a handwritten chart (which actually is a sort of scrapbook and includes things the patient might have brought in like newspaper articles and specimens …”this was stuck in my ear, doc”.) There is also a lot of unwritten meaning in a handwritten chart: Bold writing. Weak writing. Unfinished sentences. Colorful pens and pencils. Circles around words. Writing also reminds the reviewer of moods and feelings that one might have had whilst writing the original. Was I laughing at the patient? Or distrustful? Or incredulous? All this is added information. The rapidity with which we can assimulate meanings when we see our own handwriting compared to when we are reviewing sterile printed text seems obvious. We are more efficient, therefore, when we review old charts.
It may be, however, that the sine qua non of handwriting advantages lies in security and HIPAA. Once digital, forever public. It could well be that future patients will demand that their health care information be in handwriting (or encoded).
That was harsh. Sorry.
It’s all there for you. I’m not your gofer.