What Medical Economics Got Half-Wrong, and Half-Right, in its EHR Survey Report | Mark Hagland | Healthcare Blogs Skip to content Skip to navigation

What Medical Economics Got Half-Wrong, and Half-Right, in its EHR Survey Report

March 11, 2014
| Reprints
A recent online survey of physician satisfaction with EHRs revealed a fascinating mixed picture

In a recent online survey of its readers, the physician business publication Medical Economics probed the views of physicians in practice regarding the purchase and implementation of commercial electronic health record (EHR) systems.

Among the survey’s findings: nearly 45 percent of readers had spent more than $100,000 on EHR systems; about 77 percent of the largest medical practices had spent nearly $200,000 n their systems; 45 percent said that patient care is “worse” since implementing an EHR; 65 percent said their EHR systems are resulting in financial losses for their practice; 67 percent dislike the functionality of their EHR systems; and nearly 79 percent, when asked if their EHR investment was worth the effort, resources, and cost, said, no it has not been.

As MedEc’s editors put it, “Physicians are frustrated with the current state of electronic health record (EHR) technology, according to data from a recently released national survey of nearly 1,000 physicians commissioned by Medical Economics and administered by MPI Group. System functionality and cost are the primary drivers of this sentiment. Interestingly enough, for doctors in practices with 10 or more physicians, functionality of the system takes on even greater significance. In fact, 74 percent of physicians reported it would influence their decision to switch systems, compared to 63 percent for physicians in solo practices. In addition,” the editors wrote, “about 57 percent of physicians in solo practice selected cost as a factor in switching EHRs. In contrast, 43 percent of doctors in practices with 10 or more physicians cited cost as a top influencer.”

Well. That’s quite a lot to mull over. Let’s begin by acknowledging the long-term editorial bias of Medical Economics as a publication. MedEc has for many years been the physician business magazine most focused on helping physicians to make the most money possible. Not only that, the magazine’s bias has always been in favor of solo and small-group fee-for-service practice, and certainly years ago, virulently “anti-managed care,” and continues to be anti-regulatory and anti-government-mandate.

So is it any surprise that the publication’s readers, who tend to be those physicians still practicing solo or in smaller-sized practices, would be overall as negative as they turned out to be, in their attitudes towards implementing EHRs, under the meaningful use mandate under HITECH (the Health Information Technology for Economic and Clinical Health Act)? The dissatisfaction with the amount spent on implementing EHRs is compounded, for small-practice physicians, by the fact that the average cost of an EHR is turning out to be about double the total amount of federal stimulus funding they can receive via HITECH. Then again, the point of the program was never to subsidize the entire cost of an EHR for physicians in practice, but rather, to compel forward EHR implementation in order to force automation on a healthcare system that remained the last major industry in America to remain paper-based, going into the second decade of the 21st century.

So, with regard to some of the results in the MedEc survey around the costs of implementing EHRs, my response is that it is clear that practicing with an electronic health record is, very appropriately, becoming the cost of entry to practicing medicine in an era of heightened accountability, transparency, and connectivity in healthcare.

Now to the other side of the conceptual ledger: at the end of the full article on the survey, the magazine noted that “The national survey underscores the major disconnect between the current state of EHR software and the needs of physicians.” And that’s where the MedEc survey results move into the realm of what is reasonable and worth seriously considering. What is very clear is this: even the best of the current electronic health record systems created by commercial software vendors still fall short when it comes to optimizing functionality around areas like population health management, advanced clinical decision support at the point of care, data analytics, and, most basically, core user-friendliness and usability.

To some extent, the faults in all the commercially available EHR systems relate to the history of the development of the electronic health record, and the purposes to which the EHR has been and is still being put. In our almost surreally complex U.S. healthcare system, an EHR is not simply a clinical documentation tool, or even simply a combination clinical documentation/clinical decision support tool, but rather, also a tool for documentation for payment and for regulatory compliance; and therefore, in contrast to the patient record systems used by physicians employed by government-run, single-payer systems in, for example, the Nordic countries in Europe, EHRs here have to fulfill so many roles, it’s no wonder that they remain sub-optimal in their functionality.





I read your latest blog about Medical Economics’ EHR report with great interest. While you make erroneous, unfounded conclusions about the publication’s editorial mission and the scope of our physician readership (188,000 in print, 945,000 a month in all forms of digital media) your opinion should not try to cloud a valuable and salient point about the sentiments of physicians related to the state of healthcare technology in early 2014.

Stated simply, nearly 70 percent of physicians responding to the survey are frustrated. And these sentiments were communicated to Medical Economics from a variety of physicians in group and solo practices across the United States. As part of the survey, hundreds of physicians asked to speak with us about their frustrations. About 80 physicians submitted additional comments through direct e-mail correspondence. It’s important to note, in reporting these results, that we are actively working on helping physicians implement and use EHR systems and continue to publish best practices and report on key findings from a novel two-year study of 29 physicians as they implement these systems.

As the leading business publication for physicians in the United States, our mission has remained consistent since its founding in 1923. We seek to report, educate, and offer physicians practical solutions to help them succeed in medical practice. As we all know, we are working in a healthcare market that is undergoing transformative change that is reflected in technological advancements, insurance reform, and a regulatory environment that remains extremely challenging for most physicians.

From a business perspective, the promise of the digitization of medical practices opens up fascinating opportunities as they relate to improving communication between primary care physicians, subspecialists, healthcare systems, and patients. Technology is building this infrastructure for the future.

The unfortunate reality is that providers have not realized this vision--far from it--and this sense of frustration is related to the usability of many EHR systems on the market. We feel that this collective view from physicians regarding the healthcare information technology (HIT) sector provides valuable information as developers and companies look to improve the usability and functionality of these systems.

And that is the point: Physicians are not yet seeing improvements in efficiency by adopting technology. From a physician’s perspective, many of the current EHR solutions are forcing them to work even longer hours to remain viable, during a period when healthcare is looking to reduce costs overall. All of this has exacerbated the economic pressure on most practices.

What we found interesting about this survey is the greatest level of dissatisfaction with EHR systems actually came from practices with more than 10 providers, not solo physicians, as you imply.

While we clearly recognize that EHRs serve a crucial role as it relates to clinical documentation, billing, coding, revenue cycle management, population health, communication, patient engagement, etc., it’s important to point out that cost is an issue for physicians. And we believe it offers another valuable insight to HIT companies as they look to build more robust solutions. Some physician practices simply cannot afford spending 10% of monthly revenues on technology solutions, unless they are truly delivering a quantifiable financial benefit to the practice. Margins are just too tight for most practices.

If you took one message from this survey, it is this: nearly 70% of consumers (physicians) of health information technology products question whether the push to implement EHRs in practice have been worth it. Yet, nearly half or more of physicians are actively using smart phones and tablets. It’s powerful data, and it shows a disconnect.

As a leader in healthcare, we are helping physicians advance in the implementation and use of technology, and we believe it’s just as important to communicate important information from physicians to help the HIT sector deliver solutions for the benefit of patients, physicians, and EHR companies.

Daniel R. Verdon
Group Content Director, Medical Economics

Daniel, thank you very much for your sincere and thorough comment just now. We are agreed that physicians in practice are not yet seeing the full fruits of EHR automation. As I stated in my blog, there are many legitimate reasons for their frustration. Perhaps one of the elements here that might be mentioned is that our core audience at HCI is CIOs and CMIOs, and of course, part of their frustration is in trying to help support physicians in the use of EHRs--use that is now federally mandated--while working with EHRs that are, as I said in my blog, largely suboptimized at this point. It is interesting to look at the two different elements covered by my blog--that element, as well as the element of physicians' unwillingness to invest significant funding into activities from which they don't see immediate financial returns. To some extent, I do believe that the second element will ultimately become a moot issue in this particular context, as physicians are compelled forward by both HITECH (directly) and healthcare reform (indirectly). I look forward to seeing more surveys from your publication, as both of us seek to serve our readers' needs for information, analysis, and perspectives going forward, at a time of what we both agree is transformative change in healthcare. Thank you very much for your comment and your thoughtfulness!