There’s no incentive for EMR utilization in the field. Small practices (< 5 physicians) make up 95% of all ambulatory businesses (70% are solo) and see 70% of the 900 Million patient visits per year. These groups have seen their costs increase 40% since 2000 and revenues decline 17-35% depending upon who you ask.

Who are we going to share all of our information with if we drive physicians out of business? The largest study of EMR based practices (see below) shows adoption causes 15% productivity losses for up to a year. All joking aside, physicians are economically rational human beings. Until there is a clear, concrete, and solid benefit, (P4P isn’t even close) physicians won’t adopt EMR even if its free because productivity losses are economic suicide – especially when your margins are in a vice grip.

Are we building on sand? When it comes to choosing EMR, doctors have no choice. Yes, there are the case studies pampered by the vendors, led by strong executives, project managers, and retained earnings to weather the economic storm. For the general user though – the news isn’t all that bright as the largest and most independent studies have shown. (Notice you don’t hear much about these?)

EMR has NOT been shown to improve care:
http://news.yahoo.com/s/nm/records_dc;_ylt=AnDw8HYwnjuFZcfJWmQ3lEKs0NUE

HAS been shown to likely INCREASE the cost of Medicare
(http://content.healthaffairs.org/cgi/content/full/25/4/1079)

HAS been shown to cause productivity losses and no discernible ROI in the field :
(http://www.rpiusa.com/Con_05_Oct_slow_start%5B1%5D.pdf)

What I’m talking about is healthcare leadership defining standards on what goes into the design. Too many times I’ve seen a product that does not provide industry common documentation. How does that happen? It happens because companies build on what they know, which is most likely outdated regulations as far as current healthcare practices are.

If healthcare leadership steps up to the plate to define these standards, and how to keep them up-to-date, we can get that well designed product that requires little training and wider acceptance.

I think that we’re at the healthcare IT tipping point. (Other industries have been reaping the benefits of IT for decades.) In any case, all the new doctors coming out of med school are steeped in the technology. Still, I’m not opposed to mandating the use of technology for the more recalcitrant doctors. We know its better and we know there are growing pains and temporary productivity losses, but the long term gains are certainly worth the pain.

Of course, what is really needed is accepted healthcare it standards for operation and interoperability. As well, the software needs to improve as to not be so difficult to use!

I have personally witnessed several physician practices express disappointment and anger about their EMR systems, only to become more positive after 6-9 months of use. Said another way, their opinion changes after they’ve worked out the initial kinks and familiarized themselves with the new technology. The first few months are the hardest.

I don’t intend to point a finger of blame at EMR vendors, but I often wonder how many physicians purchase these systems on the promise that you turn a switch and all your problems are forever solved. Unfortunately, even healthcare IT can’t solve every problem in the physician office. (It can do a lot, though!)

I’d be interested in hearing what others think.

EMR Software Guy
http://www.electronic-medical-record.blogspot.com/