The 2006 Physicians Practice Technology Survey: Piecing IT Together

Nemishh Mehta and his wife Shilpa, both primary-care physicians, had long dreamed of working together in their own practice. The Bear, Del., residents had been working successfully in separate practices, but they were left cold at those offices by what they perceived as an impersonal style of practicing medicine.

“We wanted to do things our way,” explains Nemishh. “We wanted to get to know our patients; we didn’t want them to feel like they didn’t have time to talk to us, or that we were rushing them out of the office as soon as possible to get on to the next patient.”

Would such an old-fashioned practice philosophy hold up in the modern world of healthcare economics? The Mehtas were determined to find out.

But they were clear on one thing from the start: To survive, the physicians themselves would have to perform virtually all of the practice’s administrative functions, meaning they would need to work as efficiently as possible. To do it, they were open to implementing any technological assistance.

Their story is one of hundreds that physicians and practice managers across the country shared with us as part of our second annual Physicians Practice Technology Survey. Our purpose: to sort through all of the hype about EMRs, practice management systems, and other gadgets and gizmos and give you the straight scoop on how private medical practices really use IT.

We couldn’t have done it without them. Or you.

Survey reveals tech-savvy docs

Some 365 physicians and practice managers nationwide completed our online tech survey, with three out of four respondents representing small practices of five physicians or fewer. Respondents split evenly between primary-care and multispecialty groups (51 percent), and medical and surgical specialty groups (49 percent).

What strikes us most about the responses? It’s how far practices have come in just a few years in their attitudes regarding the necessity of - or at least the added convenience and efficiency offered by - healthcare IT.

Ira Rubin, a primary-care physician in Naperville, Ill., recalls his four-year effort beginning in 1990 to convince his partners just to buy a computer. Once persuaded, Rubin says, “It took about six months to convert our billing records from old ledger cards to the DOS program. After that, there was no going back. … There were a number of glitches, but overall we have become more efficient [and have] generated more income.”

From skepticism about the need for a basic PC to a cautious openness toward complex, expensive EMRs and other technologies, physicians appear to have taken major strides toward becoming tech-tolerant if not downright tech-savvy, if our poll is any indication. For the most part, physicians told us that they have come to terms with (and are even mildly enthusiastic about) the growing use of EMRs and other practice management technologies.

Daniel Lazar was the head cheerleader for purchasing an EMR for his primary-care practice in Skokie, Ill. He told us that the transition was “intense,” as expected, requiring him to take several days away from seeing patients to familiarize himself with the system. But for the most part the EMR has made practicing easier and more lucrative and has made him and his partners better physicians, he says.

For example, Lazar loves the drug-interaction warning system his Misys EMR contains. He raves about being able to work from home when he’s on call. But his favorite benefit of the EMR is the ability it’s given him to provide better service to his patients. And that benefit extends to his interaction with other doctors: He can quickly pull a patient chart when they call unexpectedly.

“Overall the quality of care has truly improved,” Lazar tells us. “Legibility and access to records, as well as access to data within records, have all contributed to improved quality.”

Resistance is futile

Scared of progress? Resistant to change? Not the docs in our survey.

Alan Grimes, a primary-care physician in Kansas City, raves about his tech-enabled practice: “We have had great success with our EMR [from e-MDs] … and have had fantastic patient acceptance and appreciation. We have also managed our time significantly better and reduced the hassles of our healthcare environment locally by using a fax server rather than a fax machine. This virtually eliminates refaxing items from our end and eliminates busy signals from other offices.”

Internist Samuel Purpura of Southampton, Pa., says his office is “essentially paperless,” and the benefits he’s reaped from his EMR are “too numerous to name them all.” But he does articulate several. “I can provide patients with their test results very quickly, coordinate their care even from home, check for drug interactions at the point of care, fax their prescriptions to the pharmacy, [and] review the patients’ health alerts based on age and diagnosis easily,” he says. “The system allows me to keep my overhead very low. This subsequently allows me to spend more time with my patients. I believe this is reflected in my recent office patient satisfaction survey, in which my patients rated my office overall with a 98.6 percent satisfaction score.”

And then there are the Mehtas. Nearly three years after quitting their jobs and launching their own practice together, they’ve discovered that it is indeed possible to make ends meet and practice old-fashioned medicine - but not, perhaps, without help from newfangled technology.

The Mehtas opened their practice with no employees save themselves. Although they have since hired some part-time staff, the physicians themselves handle most of the practice’s administrative tasks.

The Mehtas knew their strategy would create challenges even as it saved them money. That’s why they decided that their practice would have an EMR from day one, even though neither had ever worked with one before. Today they credit their EMR as a key reason for their success. “It was really hard,” says Nemishh, but “the EMR does help quite a lot.”

Running the new practice with an EMR from its inception, rather than adding the technology to an existing practice, has made implementation much easier, says Nemishh. For one thing, there were no conversion issues to deal with - no paper to scan, no work processes to be revamped, no resistant physicians or employees to be trained. And the initial lean period new practices typically experience when they open - seeing only a handful of patients a day - did provide an opportunity to spend time learning the system.

Nemishh Mehta’s favorite EMR feature is an independent online forum for eClinicalWorks users like himself, where he can get unvarnished advice and share tips with other users and prospective buyers. The forum, eCWusers.com, is run by a physician user rather than the company (although its officials visit the site and offer their views and suggestions). Nemishh says that makes him feel he can trust that the views expressed in the forum are authentic.

“I’m on here seven times a day,” he says. “In fact, I have it on my screen right now. It’s a place where you can get support and advice - and it’s a place where people can commiserate.” (eClinicalWorks isn’t the only EMR vendor whose clients have formed an online community. A simple Google search will help you determine if there’s a user forum specific to your EMR, or one you’re considering purchasing.)

Docs describe EMR experiences

Highlights of our survey results regarding EMR usage and implementation include:

• Like last year, EMR adoption is higher than many experts and observers have predicted, but interest may be waning somewhat. About 35 percent of our survey respondents said they already have a fully implemented EMR, while another 40 percent are in some stage of shopping, purchasing, or implementing one, or they are using an EMR provided by an affiliated hospital. About one in four respondents still insist they’re not interested in the technology. Last year, 41 percent of respondents were already using EMRs, and only one in five said they were uninterested.

• Of those practices in the market for an EMR, most expect the selection process to go quickly. A full 77 percent of respondents shopping for an EMR expect to make their choice within six months (or they report that that’s how long it took them to select the EMR they’re using). Only 12 percent expect their purchasing decision to take longer than one year.

• Many of the practices that have already purchased EMRs found their implementation process to be surprisingly quick. Fifty-eight percent of respondents said it took only about a month to implement their EMRs, up from 49 percent last year. Only 17 percent said, “We’re not there yet,” compared with the 23 percent who were struggling with implementation issues last year.

• Many EMR-enabled practices recognize the technology’s financial impact. For example, about half of the responding practices reduced staffing levels as a result of acquiring an EMR (up from 42 percent last year), and 88 percent agree that, overall, their EMR has streamlined their workflow.

• On the other hand, we were surprised to learn that only 40 percent of practices said they expected to see any ROI, and only 28 percent said they’d earned back in efficiency more than they’d spent on overhead. Daniel Lazar, for example, says that for all the benefits of his practice’s EMR, it is “really hard to measure” whether it’s had an overall positive affect on his practice’s bottom line. With interest in EMRs surprisingly high, and expectations of ROI surprisingly tepid, it appears that many practices are prioritizing advantages other than financial benefits as their motivating factor for purchasing the technology.

Not always a bed of roses

We heard lots of EMR stories with happy endings. But physicians are not technology Pollyannas. While largely optimistic, many also declared themselves nervous about the costs of EMRs, worried about implementation issues, and skeptical of potential technology partners.

We heard cautionary tales about fly-by-night vendors and companies that don’t clarify the fine print in their contracts.

Lawrence Pasik, MD, in West Bloomfield, Mich., told us the EMR provider his practice chose seemed financially sound until its checks - payments for a data-sharing program - began bouncing: “The company is either out of business or close to it. They had only five employees the last time we contacted them,” down from 200, Pasik reports. “We have moved on to another medical records program, but there are problems.”

Johnny Chang of Avon, Conn., says his EMR “actually made for more paperwork, not less” within his practice. Karen Pryce, the administrator of a practice in Ashboro, N.C., describes “the upfront and unexpected costs associated with preparing to implement an EMR” as a “nightmare.” She adds that the “IT knowledge deficit within our office made it very difficult to understand terms, conditions, and other issues of the EMR negotiation process.” And surgeon Robert Feher of West Hills, Calif., wants an EMR but is worried about “cost, privacy, and typing input with [the] patient in the room.”

Many of you registered complaints about common technologies other than EMRs. Connie Merrell, the administrator of a surgical group in Boise, Idaho, says her practice recently added voice recognition software because “we felt we needed to make some move into the 21st century, and we’re not ready for an EMR yet.” Voice recognition seemed like a nice first step for the two-physician group, says Merrell.

But results have been mixed. One of the physicians likes the system more than the other. The technology itself works well enough, Merrell explains, “when we use it properly. If the doctor speaks clearly, it picks it up pretty well, but sometimes when they’re tired, they mumble.”

Ultimately, the cost of the vendor’s technical support rather than the technology itself has Merrell the most upset. She says she was surprised to discover that the vendor they chose charges a flat quarterly service fee of $1,070, regardless of how often the practice needs help. “We don’t call very often - maybe once every three months - but if you don’t pay, they won’t service you at all,” she says. Merrell wants to cut ties with the company, which she says didn’t fully explain its service charge before the contract was signed, but the practice isn’t yet confident enough in independently using the new technology to risk going forward without any support. “I am so disappointed by this that I will look forward to going to an EMR in the future and telling this company we no longer need them,” Merrell says.

But the vast majority of complaints we received came not from practices uneasy about technology in general, but rather from those disappointed by the results of their good-faith efforts to boost efficiency through technology, usually because they picked a vendor that was more intent on making a sale than on providing service. Indeed, we heard very little of the “Who needs technology?” attitude that some believe is typical of physician practices.

Docs talk about other IT usage

Of course, EMRs aren’t the only tech game in town. Here’s what you told us about voice recognition technology, practice management systems, and other gadgets and gizmos:

• About one in five respondents are using voice recognition technology, the same number as last year. Most practices say it saves some money on transcription costs, but not much time.

• Forty-four percent of respondents say they’re using coding software, also about the same as last year. It’s a wonder more physicians don’t look into such software, since 82 percent of those who use it say it has helped increase revenue - if only a little.

• It appears many practices have been busy the past few years buying new practice management software, as 71 percent said their systems are no more than four years old. Still, for the 10 percent of you using systems you bought during Bill Clinton’s first term (or even prior to that), perhaps it’s time for an upgrade. Especially since…

• There continues to be a significant amount of dissatisfaction with practice management systems. Only a third of practices responding to our survey say their systems do everything they want them to do, the same number as last year. And just like 2005, about six in 10 wish their systems had more robust reporting capabilities.

We also asked what, if anything, practices are doing online. We found that most are only inching toward taking full advantage what the Internet has to offer:

• About four in 10 respondents say they communicate with patients via e-mail, but hardly any practices charge patients for the service.

• About six in 10 respondents have Web sites for their practices, but very few have interactive features such as online appointment scheduling. Most practice Web sites are informational only.

Lazar cited such a Web site - one that would “enable patients to make their own appointments, fill out all necessary forms online prior to [their] appointment, and enable me to communicate with them via e-mail” - in response to our question, “What would be your dream gizmo?” He adds that he knows interactive Web sites are not really “a dream,” but he says developing one would cost too much.

Other respondents’ dream gizmos? Many physicians hope for a handheld personal digital assistant that can act as an EMR, take dictation, connect them to the hospital, place phone calls, give driving directions, and recommend a good restaurant. Some want better voice recognition systems, others want access to patient records from anywhere, and still others dream of one day learning to use some feature of their existing technology. For example, dermatologist Marla Klein says she “would like to be savvy in sending prescriptions to pharmacies by e-mail,” adding she knows her EMR can do that. “I just haven’t learned how yet.”

Ken Ponder of Niceville, Fla., made us laugh by revealing his Star Trek geekiness when he identified a “tricorder” as his dream gizmo, referring to the handheld device Dr. McCoy used to examine patients.

Tricorders are about as close to reality as antigravity boots and jet packs. But what’s been holding healthcare back when it comes to IT has been the hesitancy of many private practices - where most Americans get their care - to adopt it rather than a lack of available products. The 2006 Physicians Practice Technology Survey suggests that’s changing.

Bob Keaveney is the executive editor of Physicians Practice. He can be reached at bkeaveney@physicianspractice.com.
This article originally appeared in the September 2006 issue of Physicians Practice.