EMR Adoption: Starting to Evolve or Still Stuck in the Past?

Gienna Shaw, February 23, 2010

In preparation for my new beat as technology editor for HealthLeaders Media, I've been reading back issues of HealthLeaders magazine.

One story in particular caught my eye: a 2007 cover story called EMR Pushback with the catchy subhead "Will physicians ever give up their paper?" A good question at the time—and still relevant today. In the article, we listed the top five reasons physicians groups were resisting EMRs, according to the Medical Group Management Association:

  • Lack of support from members
  • Lack of capital resources
  • Concern about the ability of physicians to input data
  • Concern about the loss of productivity during transition
  • Inability to easily input historic data

Sound familiar? There have certainly been many developments in EHR implementation—not the least of which is the American Recovery and Reinvestment Act of 2009 (ARRA). So where do we stand on EHR resistance in 2010?

Money is always an issue
Despite ARRA's HITECH provision, which offers more than $30 billion in incentives, the basic questions about how EMRs will impact practices remain largely unanswered, says Sam Harrison, MD, who retired from a four-physician urology practice in Bryan, TX, two years ago.

"We as physicians remain concerned about expensive purchase costs, lack of support, loss of productivity during both implementation and beyond, and the time and resource costs of retrieving, scanning, and populating an EMR system with the existing legacy paper charts," he says. "Mix in a healthy dose of the [inevitable costs of] future system obsolescence, including software updates, hardware replacements, and maintenance, and what you have is a quick recipe for physician headache and heartburn."

"The money is always, always an issue," says Greg Spencer, MD, chief medical officer of Crystal Run Healthcare, a group practice in New York with about 200 physicians. Paper costs money, too, he says, but that feels more like a "normal" expense.

In the 2010 HealthLeaders Media Industry Survey, about 20% of CEOs said technology is one of the top three drivers of cost—it ranked seventh overall, way down from 2009, when it ranked third.

Of the 80% of CIOs who said clinical IT spending will increase in the next five years, a little more than half said that increase is due to HITECH. Fifty-six percent say spending on clinical IT will increase because of HITECH.

Hospital and health system CIOs say they're prepared to achieve meaningful use: 76% said they are on target to have systems in place in 2011/2012 and capture full reimbursement.

Results of the survey suggest that physician-owned organizations may be faring better than their counterparts that are owned by hospitals or health systems.

Physician-owned practices were more likely to say they'd be ready to receive stimulus funding in 2011. Nearly half of physician-owned practices (48%) expect to receive meaningful use funds for an EHR system in 2011, compared to only about 35% of practices owned by hospitals and health systems.

Overall, 41% of all practices said they'll take advantage of ARRA funds to install or upgrade an EHR. Nearly 35% said it's too early to tell. And a little more than 6% said, "No, it's still too expensive."

The transition issue will never go away
Other concerns that haven't gone away: loss of productivity during transition periods and reliable, easy data input. The interface between humans and computers has improved, but it's not perfect, says Spencer.

"Voice recognition software is much further along, but it's not at the point of human dictation," says Spencer, who uses the latest version of Nuance's speech recognition software, Dragon. It's "remarkable," he says, even "awesome," but "it still makes silly errors" and you still have to make corrections.

The transition issue will remain a big pain point—regardless of how technology evolves. "There is a learning curve, no matter what, no matter how good the system," he says.

Meanwhile, only 12% of CEOs said in the 2010 survey that technology and system equipment were among their top three priorities for the next three years—technology ranked eighth overall. Among physician practice leaders, technology ranked sixth in terms of priorities over the next three years.

The steady move toward adoption
Harrison, who is now co-owner of an investment company and who advocates for state and national healthcare initiatives, says the answer to two simple questions could prompt widespread adoption: "How will an EMR impact our bottom line? And will it allow us to see more patients and thereby allow us to pay for the system?"

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