2009 Tech Survey: Taking the Plunge

Maureen Horton remembers a time a few years ago when four and a half jobs at her busy primary-care practice were dedicated to “just moving paper charts around every day.” The chief administrative officer at San Ramon Valley Primary Care in California says the practice had expanded their filing and medical records space, but with 13 physicians, eight pediatricians, and 30 patient rooms, juggling paper charts was becoming overwhelmingly inefficient. “It was literally impossible to deal with things efficiently when you were looking for charts,” says Horton. The practice has since implemented an EHR (and recently upgraded to a new, compatible practice management system), allowing it to trim to about one and a half full-time medical record positions responsible for scanning documents into the system, resulting in a “huge” cost and time savings. They haven’t seen a new paper chart in three years, Horton says.

According to the 2009 Physicians Practice Technology Survey, most practices using an EHR report the technology has made their work flow more efficient, and nearly 62 percent have seen or expect to see a return on investment. But that’s among those actually using an EHR, and this year’s findings mirrored previous years’ in reporting that just about one-third of respondents have a fully-implemented system. The recession seems to have forced some practices to tighten their purse strings, but the federal government’s promise of incentives for using EHRs may be the needed encouragement for many still holding out.

Let’s take a closer look at the survey results, including how many practices like yours are using technology and what’s holding up universal implementation.

Cost hang-ups

Nearly 36 percent of surveyed practices have a fully-implemented EHR (only slightly above last year’s 34.7 percent), with another 22 percent saying they plan to buy one in the next 12 months. Most EHR adopters report the systems are worth the investment, but if you’re still concerned about cost, you’re not alone. Nearly 58 percent of respondents named the cost of implementing and using new technology among the most pressing IT problems. “When you start looking at dollars, even with promised money [from the economic stimulus package], it’s still a big pill to swallow,” especially for smaller practices, says physician informaticist Stephen Beck, who helps physicians in the multihospital network of Mercy Health Partners in Cincinnati implement EHRs. The cost of an EHR is still all over the map, according to our survey. Although it’s hard to pin down exactly how much you should be paying, the range of costs does offer a window into what other practices are doling out. About a quarter of respondents paid or expected to pay between $500 and $4,000, and more than 40 percent paid between $4,000 and $12,000. A full 24 percent dished out $12,000 or more, while 9 percent paid less than $500.

The recession seems to have added insult to injury. In fact, 40.8 percent of respondents this year said they were putting off tech purchases because of the recession. About 21 percent said their purchases would depend on whether the vendor can prove the product will make money. “We probably would have thought about it twice had we known the recession was coming, but we were already plugging along,” says Laura Shea, a primary-care physician at Brookside Family Medicine in Traverse City, Mich. Perhaps luckily, her practice already was deep into researching the EHR they implemented a few months ago. But, she adds, the recession just means you have to be savvier with what you buy, a sentiment with which tech experts agree.

Rather than a time to halt spending, the recession should be an opportunity for technology investments, says Rosemarie Nelson, a consultant with the Medical Group Management Association. “Practices absolutely should be moving forward,” she says. They should be considering ways to boost revenue - not just cut costs - and many technology tools can increase efficiency. This means more patients and more money, Nelson says. If you’re not ready to dive into an EHR purchase, consider other tools, such as e-prescribing.

A federal boost

If cost is the main barrier to adopting an EHR, the landscape is sure to be changing as practices take advantage of the federal financial incentives included in the economic stimulus package. In fact, even before the EHR stimulus package was finalized, nearly 16 percent of respondents said the Obama Administration’s pro-EHR stance makes them more likely to buy an EHR. Forty-one percent said they were waiting to see what kind of incentives or mandates were passed down from the Obama administration. “Physicians who have been waiting for [financial incentives] have been looking for help,” says Horton.

Starting in 2011, under the American Recovery and Reinvestment Act of 2009, practices that show they are “meaningfully using” an EHR could receive Medicare subsidies of up to $44,000, or nearly $64,000 from Medicaid over a five-year period.

These incentives change the perspective on tech buys, says consultant Bruce Kleaveland, who adds that his advice for making purchases when finances are tight might have been different had it not been for the stimulus bill. But now practices have a “once in a lifetime opportunity to have the government contribute to their tech investments,” he says. Meanwhile, vendors have responded by actively promoting the benefits of their EHRs and educating practices, Kleaveland says.

Vendor follow-through

But as our survey results reveal, the relationship between IT vendors and practices continues to be strained. A few of the most common responses to a question asking for “advice to vendors” characterize this frustration:

• “Don’t over-promise and under-deliver. Be honest about what we’re getting. Make sure there is enough training built into implementation.”

• “Tech support, tech support, tech support. You need follow-up tech support - don’t just sell the product then disappear or have a rep that serves 10 states!”

• “Tell the truth, provide support after the purchase, listen to your users.”

Indeed the relationship after the technology purchase is essential for successful implementation. Nelson encourages practices to ask the vendor if they can meet some of the implementation team. Try asking to view résumés - without names and contact information - to see if the support team has worked with practices like yours before. After all, these are the people you will be working with, so why not check them out and gauge their experience level? Selecting the right EHR takes time, so do the research and develop a strong relationship with the vendor. “There’s no question you have to have a comfort level with the vendor,” says Julio Sosa, a plastic surgeon in West Bloomfield, Mich., whose practice adopted an EHR about a year and a half ago that he says has boosted efficiency and will likely save them “tens of thousands of dollars.” But no system is perfect, he adds, so the practice “should be able to pick up the phone and actually talk with someone.”

Practices also need a champion on their end who can ensure smooth communications with the company, says Kleaveland. “You can’t just assume the vendor can manage the requirements for the practice - the practice has to have someone in charge that can be a direct liaison with the vendors,” he says. “Well organized customers are going to have better experiences because they are going to be in a position to be more efficient and more effective in interacting with their vendor.”

Practice management software lags

While the stimulus hype has kept the spotlight on EHRs, many of you are still using ancient practice management systems. Thirteen percent of respondents are using PMS software they implemented more than 10 years ago, and 34.6 percent implemented their systems between four and 10 years ago. More than 9 percent of practices reported they still aren’t using practice management software, but the amount of holdouts has dipped from last year, when 12.7 percent said they weren’t using the software.

And, perhaps not surprisingly, most of you report your PMS software is falling short. Fifty-four percent said the software doesn’t do everything they want it to (down from last year’s nearly 60 percent), adding they want better reporting and a more intuitive interface. Several practices elaborated that they want the software to interface with their EHRs, and Beck points to compatibility between systems - both within a practice and practice to practice - as one of the greatest tech challenges. “There’s lots of great software available,” he says, “but the communication between the two is still not where it needs to be.”

Other tools slow to catch on

E-mail communication with patients is still slow to catch on, with two thirds of practices reporting they don’t do it, the same percentage as last year. Although privacy concerns dominated the reasons for not e-mailing, others said they don’t have time or they can’t get reimbursed for the task. Sixty-six percent of practices have Web sites, but a whopping 77 percent of those sites aren’t interactive, which would allow patients to send a message or request a prescription refill, according to the survey.

The adoption rates for software to select appropriate CPT and/or ICD-9 codes dipped this year with 42.5 percent (down from 50.6 percent) of surveyed practices reporting they use coding software, even though about half of those who do say their revenue has grown (21 percent of practices seeing growth of more than 10 percent).

Some of the numbers might suggest there is truth in the stereotype that physicians are a tech-phobic bunch. Not so, says Beck. “I believe most physicians embrace technology. Getting to the technology and the hurdles they have to overcome is one piece, and the other piece is change management,” he says. “Physicians are afraid of changing what they are comfortable doing rather than fearing the technology itself.”

* Editor’s Note: Read the complete survey results to find more detailed numbers, including insight on how other physicians are implementing technology in their practices.

Sara Michael is an associate editor with Physicians Practice. She can be reached via sara.michael@cmpmedica.com.

This article originally appeared in the September 2009 issue of Physicians Practice.