EHR Adoption: Despite Progress by Medical Practices, Miles Left to Go

Last week, I listed some interesting insights from the latest Physicians Practice Technology Survey. This week, some more observations:

Staffing:ROI not achieved,  but that shouldn’t be the end game for EHRs

Almost half of respondents said they had kept staffing the same after implementing an EHR. Those who said they added staff (17.1 percent) was almost identical to those who said it wasn’t yet clear whether EHR will impact staffing (17 percent). Only 3.6 percent said they had laid off staff. This is a major flaw in EHR thinking; that it will reduce staff. That’s not the primary point of an EHR, it is to improve quality, deliver better patient care, decrease medical errors, improve documentation and tracking, reduce inefficiencies, and give patients and staff the tools they need to better manage outcomes. It’s no surprise that the results for this statistic are muddled, because in our experience, very little optimization and improvement on existing processes is done in conjunction with an EHR implementation. We frequently see that old processes - particularly paper-based processes - continue indefinitely alongside a new EHR. Sometimes it is habit, sometimes it is just resistance to change, and there are various other reasons. We have seen complex processes and forms kept in place for one or two pieces of information that are not even very essential. So it is frequently the case that staff and administrative costs stay the same or even increase post-implementation. As one healthcare expert stated, one person’s inefficiency is frequently another person’s paycheck.

Vendor dissatisfaction is getting a lot of publicity - perhaps overstated?

In answering the question "How satisfied are you with the vendor you selected," only 13.5 percent answered either dissatisfied or very dissatisfied. That meant a total of 86.5 percent of respondents were either "in the middle," "satisfied," or "very satisfied." In fact "very satisfied" at 14 percent was more than triple "very dissatisfied," at only 4.1 percent. Given the somewhat "forced march" of ARRA/HITECH, which brought a lot more players into the EHR adoption process, with many of them not being pro-technology early adopters, I am surprised the dissatisfaction numbers are not higher.

Meaningful Use: Not so meaningful?

Only 61.7 percent of respondents said they had been successful in qualifying for the Stage 1 requirements of meaningful use, and had received their money or notification thereof. A surprisingly high 14.3 percent said they had gone through the process and had failed and didn’t think they would ever be successful. This is surprising because for Stage 1 all a provider needed to do was "attest" to meeting the guidelines for 90 days. While it would be foolhardy to attest without substantiation, the requirements are not that substantial. Perhaps the most surprising statistic from the entire study related to Stage 2 rules for meaningful use, where a whopping 13.6 percent stated they did not plan on attesting for Stage 2. This means that out of $44,000 total incentive funds (for Medicare Eligible Providers), they are only going to receive $18,000. Only 25 percent said they had reviewed the Stage 2 requirements and were making changes to attest going forward. The remaining respondents were either still focused on Stage 1 or were only somewhat familiar with Stage 2.  The published results do not state whether some of these numbers are skewed by providers who are not eligible for ARRA/HITECH stimulus funds, but presumably only those who would qualify would have answered the questions the way they did.

It has always been our opinion that ARRA/HITECH and the pursuit of meaningful use funds are not the primary reasons to implement an EHR, but they certainly can help providers and clinics who feel that EHR adoption is a good strategic move for them and their patients.

Lots of work left to do

In summary, while EHR adoption is clearly continuing to increase, there are significant hurdles left to overcome, and the healthcare industry has a long way to go to catch up. By one measure at least - staff headcount - improved efficiencies have not yet been achieved. Those who claim that EHR implementations are a nightmare are not supported by the facts. Meaningful use has not produced the results that many thought they would, with a large number of providers bailing out on Stage 2.