As we look at the current state of physicians’ use of electronic health record (EHR) products, two significant factors appear to be driving demand.
First, as the market continues to see an influx of new physicians trained in medical school to use the latest technologies who are moving into practice or leading medical and research centers, demand for leading technology is expected to be a big influencer in their employment decisions. Second, and perhaps the strongest driver, is the all too familiar EHR Incentive Program under the HITECH (Health Information Technology for Economic and Clinical Health) Act. Meaningful use(MU) coupled with the goal of getting more physician practices wired and ready to submit quality performance results to earn reimbursement is well under way. CMS reports, in fact, more than 70 percent of physicians have “adopted” an EHR.
But what does adoption really mean? Many physicians are struggling to use the current point-and-click systems for a number of reasons. Oftentimes poor integration, workflow design and minimal query capabilities are to blame for low usability. As a result, achieving MU has become a simple exercise of “clicking the box” to receive incentives rather than truly utilizing the EHR to achieve quality improvement. MU has also created significant unintended consequences including:
> An artificial market of immature products,
> Accelerated implementations to meet incentive deadlines,
> Rushed vendor retrofitting of software to meet ONC certification standards,
> “Required” practice changes or data captured that is not relevant for all specialties,
> Increased data entry granularity for quality reporting, and
> Perhaps the most disturbing, a trend among some physicians to stop providing care to Medicare patients to avoid the resulting scheduled MU payment adjustments.
Looking past initial MU compliance, a high functioning, widely adopted EHR is essential because documentation requirements will only increase with value-based payment models.
In the past, physician resistance to change has been pointed to as the culprit for low adoption rates. However, one might argue that physicians are no more resistant to change than the general population. What is clear is that generational differences affect clinician technology usage. These differences may account for slower adoption rates in some physician populations; however, it is also true that when more tech-savvy physicians experience a move from a well designed EHR to a poorly designed one, the resulting frustration is the same. This supports the argument that while the generational gap is a factor, inherent design issues or inadequate or rushed implementation decisions are the most probable root cause for the uproar.
The industry is well on the way to “adopting” technology to improve care. The current challenge is to focus on usability from the clinician’s perspective, particularly physicians. The Wall Street Journal article, “Christensen, Flier and Vijayaraghavan: The Coming Failure of 'Accountable Care'” published Feb. 18th suggests significant changes need to occur in the way physicians think, behave and practice in the era of value-based reimbursement. Expecting that this change can occur, the continued use of EHRs deemed difficult to use is unrealistic. Dr. Lucien Leape and others maintain that a primary cause of physician cognitive errors is simply process problems. Inefficiencies or software misalignment with processes and practices can have serious impacts on patient care such as reduced physician-patient interaction time; increased time spent responding to irrelevant alerts; and, poor communication among care providers because of a lack of a clear narrative. According to a recent AMA study, the next decade will bring an estimated primary care physician shortage of 60,000. With a shortage of this magnitude, tools and best practices to improve efficiency and effectiveness become imperative.
The adage “put the problem where the solution is” has never been more applicable than the need to improve EHR usability. However, we can’t expect the problem of poorly designed products to be addressed immediately. The interim solution is software optimization and processes/practices alignment until the market - and government standards - drives better usability.
Though the HIT vendor market is booming, some experts predict a crash is inevitable as adoption rates slow. With smaller market share, surviving vendors will need to compete with better designed EHRs. Recent Black Book polls indicate almost 50 percent of physician shoppers in 2012 were replacing their electronic medical records system, and that one in six medical practices may switch in 2013 – which is no small investment. Is this an indication that the physician’s voice and check book are change agents for better design? Perhaps. In this volatile market, buyers beware.
In our next guest blog, we will discuss options for EHR optimization by implementing new solutions that enhance usability and improve practice operations and physician workflow to meet new demands during the transition to value-based payment. We will also share predictions on emerging technologies expected to alleviate some of the EHR challenges facing clinicians today.
Ted Reynolds is vice president, and Marla Roberts, DrPH, R.N., is solution manager, both at CTG Health Solutions.