Wednesday, March 10, 2010

Trendspotter: Physicians Remain Leery of EHRs, Despite Government Incentives

By Ken Terry

The results of recent surveys suggest that a majority of physicians intend to buy electronic health record systems within the next few years. But software vendors interviewed at a recent annual meeting of health IT professionals aren’t yet seeing any stampede of doctors to acquire EHRs. And the Medical Group Management Association (MGMA) has expressed reservations about the ability of physician groups to meet the “meaningful use” criteria for government financial incentives. That casts some doubt on the eagerness of doctors to adopt EHRs.

A study by consulting firm Accenture shows that 58 percent of physicians in groups of 10 or fewer doctors who don’t have an EHR plan to get one in the next two years. Four of five non-EHR-using doctors under the age of 55 are gearing up to go digital, according to the survey. Three quarters of the non-users say they’d buy an EHR through a hospital if the facility subsidized it, and the average amount of subsidy these doctors expect is about half of the EHR’s cost.
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Another survey, by EHR vendor athenahealth and physician social network Sermo, finds that 80 percent of Sermo’s online users have a favorable opinion of EHRs and believe that these systems can improve patient care. Seventy-three percent say that the patient benefits of an EHR justify the financial costs. But most respondents agree that EHRs are expensive to purchase and maintain; 54 percent agree with the statement that EHRs slow physicians down; and barely more than 50 percent believe that EHRs have been designed with physicians in mind.

I’m somewhat skeptical of the latter survey, since it was co-sponsored by an EHR vendor. Also, physicians who participate in Sermo’s online network are not necessarily representative of doctors as a whole. I’d guess that a far smaller percentage of physicians view EHRs favorably than this survey indicates. As for the Accenture study, I’m struck by the fact that 61 percent of the non-EHR-users want to adopt because of the threat of Medicare/Medicaid penalties down the line, and only 51 percent are motivated by the federal subsidies for EHR adoption. What that tells me is that physicians are being reluctantly dragged into this deal.

One reason for their reluctance and their skepticism about government incentives is the difficulty of achieving meaningful use. In an MGMA survey, member practices said that the hardest requirements to meet were providing electronic copies of medical records to 80 percent of patients requesting them within 48 hours and providing electronic copies to all requesting patients within 96 hours. The majority of respondents also foresaw problems in using clinical decision support and submitting quality data. More than two-thirds of the respondents said that the use of EHRs would reduce productivity. Thirty-one percent said that productivity would drop more than 10 percent.

The latter MGMA findings and the similar one from the Sermo/athenahealth survey show that physicians remain apprehensive about the financial impact of EHRs on their practices. This impact is related not only to cost, but also to productivity. Dr. Daniel Palestrant, CEO of Sermo, commented, “It is clear from the survey that current EHR solutions are imperfect, with cost, resource allocation, and ease of use being areas that could stand great improvement. Discussion amongst the Sermo physician community supports the survey’s findings of ‘holes’ in current offerings and, more broadly, the notion that EHRs have a long way to go towards delivering on the promise of cost savings, freed resources, and better medicine.”

Nothing exhibited at last week’s conference in Atlanta of the Health Information Management and Systems Society (HIMSS) really represented a breakthrough in EHR design. Some vendors were offering components of EHRs that stressed connectivity more than documentation. That’s important, because the ability of EHRs to exchange data with other information systems remains poor. Also, many physicians find it difficult to document visits in EHRs. There have been some advances in “natural language processing,” which enables computers to parse the meaning of text and sort medical terms into EHR fields. When that’s ready for prime time, many more physicians will be enthusiastic about EHRs, because they won’t be required to enter data. But that’s probably at least 10 years away, and the government incentives for EHRs will be available only from 2011 to 2015.

In the meantime, doctors will have to adjust to the realities of current EHRs if they want to win federal subsidies and avoid later penalties. Let’s hope that as the market expands, EHR vendors will reinvest some of their profits in developing products that are easier to use and that help physicians improve quality and efficiency more than those now on the market.

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