2013 Physicians Practice Technology Survey

You might say pediatrician Alan Grimes is an IT visionary - at least in how he sees technology's role in medicine. His 11-physician Kansas City, Mo., practice has had an EHR since it opened in 2004, and today uses a patient portal, mobile devices, and even social media to better track and communicate with patients. Grimes is always looking for new and better ways to deploy technology.

"In the early years the whole point [of health IT] was getting data in - it's a way to do your records, it's a way to have legible notes, it's a way to do better billing," he says. "Now, in the past few years, the richness of it is getting data out."

Grimes' vision of EHR usage has changed in recent years. For instance, Grimes uses his EHR to more thoroughly track and monitor patients, identify high-risk patients, and attempt to improve care quality while reducing costs.

Like Grimes, many of you are implementing new technologies in practice, according to the results of our 2013 Technology Survey, Sponsored by ZirMed. But not all of you are as positive about the results, nor are you as actively exploring new and more advanced ways to use those tools.

To help turn those trends around, we asked Grimes, other physicians, and technology experts to weigh in. Here's how they said your practice can make the most of technology.

* Are you interested in finding out how your peers are using technology in their practices? Our 2013 Technology Survey, Sponsored by ZirMed, has the data.

Moving beyond the basics

Between 2011 and 2012, the number of practices that completed the EHR selection and implementation process continued to increase, according to the survey. Most of our nearly 1,300 respondents said they have a fully implemented EHR, or are using one provided by a hospital or corporate client. Among EHR users, most also have already attested to Stage 1 of the government's program for meaningfully using the technology.

Yet many physicians are not reaping the rewards of the transition. In fact, most EHR users in our survey said they have seen no return on investment.

Coastal Medical, Inc. a large multispecialty practice based in Providence, R.I., is trying to maximize its EHR investment by using it to participate in Medicare's Shared Savings Program. Under the program, if Coastal Medical provides high-quality care at lower cost to Medicare patients, it will share in the money that it saves the government. Its EHR plays a "pivotal" role in delivering on those objectives, explains pediatrician Edward McGookin, Coastal's chief medical officer. The practice uses it to monitor patients more closely, document care more consistently, and retrieve patient information more quickly. In addition, McGookin says, "The data that comes out of [the EHR] is delivered in a way that helps us recognize opportunities for improvement or see where we've already made them over time."

If using your EHR to help you provide "high-value" care seems daunting, there are some simple first steps to take, says Marcia Peterson, practice director of managed services at healthcare consultancy Beacon Partners. "What I find in a lot of practices is people truly aren't using the reporting systems within the products that they have, and many of them run just short of being able to deliver what we truly need when we talk about big data and analytics and the eventual predictive analytics," says Peterson. "A lot of them just need to start using the reporting capabilities of their systems to see what they're able to produce, what they're able to find, what they're able to identify, in order to determine what they need to take for next steps."

As you begin to explore new ways to use your EHR, don't hesitate to reach out to your vendor for help, says Jeffery Daigrepont, senior vice president of Coker Group, a national healthcare consulting firm. "I would definitely be engaging vendors as to what kind of dashboards they might have, feedback on whether they're able to monitor key performance indicators in accordance to best practices - things of that nature."

Making information instantaneous

As more practices implement EHRs, more are also participating in health information exchanges (HIEs), which enable electronic health information, such as that found in an EHR, to be shared across a network of providers in a secure and interoperable way. In fact, 37 percent of our survey respondents said they are already part of an HIE.

That may seem like a sizable number, but it should be higher, says Laura Kolkman, founder and president of HIE consulting firm Mosaica Partners. Information exchanges provide physicians access to detailed up-to-date patient information from a variety of sources. "For the patient and the provider, the ability to have a more complete picture of that patient's current health state enables the [physician] to provide more accurate, timely care," says Kolkman, who is also a registered nurse.

Coastal Medical's participation in Rhode Island's HIE, CurrentCare, allows its physicians to see what services and tests its patients are receiving elsewhere. "We know that we don't provide all the care that our patients need. We still rely on emergency room services, hospital services, and … ancillary services like lab and imaging that are not part of our group," says McGookin. "We have the access to care and testing that's been done outside of our record. That's what the HIE provides."

HIE participation will also help you satisfy requirements in the second stage of meaningful use. For example, eligible providers will need to transmit a summary of care record for more than 10 percent of all patient care transitions and referrals using a certified EHR. Alternatively, they may transmit the records via an exchange facilitated by a participant in the Nationwide Health Information Exchange Network, or in accordance with standards set forth by the network.

It's not enough to simply participate in an HIE. To get the most from it, you need to be actively engaged with it by communicating with its managers to ensure it meets your everyday needs, says Kolkman. For instance, if information from the exchange is automatically integrated into the EHR, it will be much more efficient than if physicians have to pull information from the exchange every time they encounter a patient in practice.

Finding information on the go

Mobile devices such as smartphones and tablets are also expanding physician access to information, and more physicians are taking advantage. The majority of our technology survey respondents said they use some form of mobile application on the job - and we're not just talking about using them to access the Internet, e-mail, or apps. Many are using their smartphones and tablets to access their EHRs.

Vein specialist KathyLee Santangelo, for instance, uses her tablet to enter patient information into her EHR when in the exam room with patients. The Midwest City, Okla.-based solo physician also uses it to access her EHR remotely. "I'm the kind of person who, when I get home at night, likes to check things and make sure I did all my stuff, and I can do that" with the tablet, she says.

As more practices implement EHRs, and as more physicians have smartphones and tablets in hand, it's critical for practices to ensure that physicians can merge those two technologies to experience the benefits of both. For instance, accessing information on the go improves convenience and ensures continuity of care, says Grimes, who takes full advantage of his mobile-accessible EHR. He's even accessed it from an airplane, looked up patient data, and sent a message at 35,000 feet.

Our survey indicates just how important it is for an EHR to be mobile-accessible.

Of respondents who said they have mobile capability, 23 percent said they are very satisfied and would highly recommend their EHR vendor. Of respondents who said they do not, however, only 5 percent responded so favorably.

Only 52 percent of respondents whose EHRs did not have mobile accessibility said their EHR had made their work flow more efficient, but that number jumps to 61 percent among respondents whose EHRs are mobile-accessible.

Still, Peterson cautions that mobile accessibility must come second to security. "Many of the [EHR] vendors don't have the security in place that is delivered with the product or easily implemented for the practice with the product, so it's the onus of the individual practice's IT and technology folks to ensure that security is in place when they use these [mobile] devices," she says.

Providing better access

While EHRs, HIEs, and mobile devices improve physician access to information, patient portals do the same for patients. These tech tools, which allow patients to book appointments online, view lab and test results, request medication refills, and more, are gaining traction. Nearly half of our survey respondents said they use a portal, up from one out of every five respondents in 2011. "People are discovering the advantages of the portal technology," says reproductive endocrinologist and OB/GYN Robert Wah, chief medical officer at healthcare consultancy CSC. He notes that portals save physicians and staff time and resources because portal communication is asynchronous.

For practices to take full advantage of portal technology, they must heavily promote it to patients. After all, the more patients that use it, the more time-savings it will create. Higher patient portal engagement will also make it easier for physicians to fulfill Stage 2 requirements for meaningful use, such as the requirement that more than 50 percent of patients receive online access to their health information within four business days after it is available.

The good news is that getting patients onboard with the portal does not necessarily entail a long, arduous process, says Peterson. "What we found is that most patients - and even elderly patients - which is very surprising for most people, are interested in participating in these patient portals if they know it's out there, if they know they have the ability, and if they're given a sense of informed education."

Getting social

The number of physicians using social media to communicate about their practice nearly doubled over the past two years, from 17 percent in 2011 to 33 percent in 2013, according to our 2013 Technology Survey, Sponsored by ZirMed.

One physician whose practice recently jumped on the social media bandwagon is pediatrician Alan Grimes. His Kansas City, Mo., practice's Facebook page, which is run by one of his colleagues, has over 2,000 "likes."

One reason for the success? Grimes says in addition to posting basic information about the practice such as hours and location, his colleague frequently posts links to interesting health blogs, provides short health updates, and shares fun content, such as a photo of one of the practice's physician's shoes with the question: "Which doctor do you think this is?"

"Those kinds of things really get patients involved in social media as opposed to just being a static boring information source," says Grimes. "We have patients that come in and say, 'Hey, I saw on your Facebook page that RSV is going around,' and it's just been incredibly helpful for them to increase healthcare literacy and healthcare awareness, and keep them engaged."

Exploring new frontiers

Few physicians are providing telemedicine-related services to patients, but that's likely to change in the next few years. That's according to Shane Walker, associate director for consumer health and wellness/digital health at InMedica, the medical electronics division of IMS Research.

Walker says a number of factors, including the aging population and the increasing focus on preventive care, will play a role in increasing physician utilization of telemedicine. In addition, costs associated with providing health services remotely are declining, while the number of payers reimbursing for it is increasing. "It's come down to where, for a few hundred dollars, you can be set up for a telemedicine conference," says Walker.

Currently, 11 percent of physicians participate in e-visits; and about 5 percent use special technologies to monitor aspects of patients' health status remotely, according to our 2013 Technology Survey, Sponsored by ZirMed.

ACO technology needs

More practices are considering accountable care organization (ACO) participation. To find out what technology tools are critical to ACO success, watch a video with internist and ACO participant Gregory Spencer.

Using technology to provide high-value care

Health IT expert Sumit Nagpal, CEO of Alere Accountable Care Solutions, describes how technology can help practices transition from traditional fee-for-service to value-based reimbursement in this podcast.

* Are you interested in finding out how your peers are using technology in their practices? Our 2013 Technology Survey, Sponsored by ZirMed, has the data.

In Summary

Our 2013 Technology Survey, Sponsored by ZirMed, indicates many of you are implementing new tech tools. Here's how to make the most of them:

• To take advantage of value-based incentives, EHR owners should track and monitor patients and performance.

• HIE participants should be actively involved with managers to ensure the exchange meets their needs.

• Physicians should explore whether their EHR is mobile-accessible, as this will improve convenience and continuity of care.

• Practices should actively promote portals to their patients to satisfy meaningful use requirements.

Aubrey Westgate is an associate editor at Physicians Practice. She can be reached at aubrey.westgate@ubm.com.

This article originally appeared in the June 2013 issue of Physicians Practice.