Five Health Information Technology Trends for 2012

How important is technology at your practice? On a scale of 1 to 10, internist Sangeetha Murthy says she would rate it a 9.5. The San Diego-based solo physician employs only one staff member who mans the front-desk at her practice for three hours each day. But where manpower is lacking, Murthy uses technology to fill in the blanks. "A lot of the things I use I have found by identifying a need and going and looking for something that meets that need," she says. Her searches have led her to technology large and small - from an EHR to an assortment of mobile apps.

Murthy, though, is an outlier, judging from the results of our 2012 Technology Survey, Sponsored by AT&T. EHR implementation hovers around 50 percent, and other technology - ranging from patient portals to tablets - is slow on the uptick as well. It's an understandable trend. As more and more healthcare-related tech tools emerge, so does confusion about what practices need to acquire and what they can easily go without.

To help provide some guidance, we compiled a list of five of the biggest tech trends occurring in healthcare right now, and we asked healthcare technology experts and physicians to weigh in with their thoughts and their recommendations.

* Curious about the numbers? Look at the data from our 2012 Technology Survey.

The not-so-voluntary trend

As you might have guessed, Murthy is an avid user of an EHR. She implemented the technology at her practice in 2008 (and switched to a different system in 2010) and she says, "I could not see myself practicing without it." Improved efficiency and ease of access to patient medical records are two of the key perks, she says.

But dermatologist Steven Shapiro, whose six-physician multilocation group practice implemented its EHR in September 2011, is not yet a happy customer. He says he suspects EHR satisfaction will not occur until "upwards of two years" after implementation. "There's a lot of frustration, a lot of loss of income, a lot of patient dissatisfaction," says Shapiro, noting that the system has decreased efficiency overall, and as a result, lead to increased patient wait times, longer patient visits, and fewer total patient visits per day.

Still, Shapiro, of Hattiesburg, Miss., says it was the right decision to implement the EHR. "We felt that - based on trends and where we thought medicine was going - we had this window of time and that implementation earlier rather than later would be the best way to go," he says.

The window he's referring to is the period of time practices have to receive federal incentives for meaningfully using an EHR (the Medicare incentive program ends in 2016), and the dwindling amount of time practices have to implement an EHR before 2015, when they will begin experiencing Medicare payment reductions for not doing so.

If financial incentives and lower reimbursements on the federal level are not enough to convince you that it's time to acquire an EHR, there are other factors to consider. Commercial payers will likely begin providing differential reimbursement to practices based on whether they have implemented one, says former practicing family physician Paul Kleeberg, clinical director of the Minnesota and North Dakota Regional Extension Center for Health Information Technology, which assists physicians and practices transition to EHRs.

In addition, as reimbursement shifts from volume of services to value of services, practices will need to prove that they are providing high quality care to patients, says Kleeberg, who is based in Bloomington, Minn. "It will be a lot easier to demonstrate and show quality when you have an EHR and can produce the numbers, than when all of your numbers are locked in a chart room in individual charts," he says.

The time-saving trend

Though Shapiro is struggling to embrace his EHR, his patient portal is a different story. "It's easily implemented, the patients very much appreciate it, and I think it gives us a better relationship with our patients," he says.

It's easy to understand why Shapiro is so pleased. Portals allow patients to do a variety of things online securely, from scheduling appointments, to paying bills, to sending and receiving messages. Of course, the more patients do online, the less you have to do in the office.

Portals can also cut down on the amount of time you spend on the phone calling patients to address questions, report lab results, confirm appointments, and so on. "You don't realize how much time you use when you get on the phone and you wait for the person to get on the phone, and then you have to visit a minute before you can kind of get to the issue, and then it typically will turn into three or four other questions," says gynecologist Elizabeth Harmon, who implemented a portal at her solo practice in Salem, Ore., in 2010. With the portal, patients message Harmon questions, and if the questions are easy to address, she messages back brief answers. As an added bonus, Harmon says, "you have a paper trail of what you did, too."

Here are some more portal perks:

• Patient Driver. "Patients feel more secure when a practice has technology," says Chris Mertens, vice president of Healthcare Practice, Personal Systems Group at Hewlett-Packard. They also appreciate when you offer them tools that make their lives easier, such as online appointment booking.

• Patient Engager. Portals also make it easier for patients to access their health information, and as a result, they become more engaged in their healthcare, says Shapiro. As reimbursement shifts from volume to value, patient engagement is going to play a crucial role. More engaged patients tend to be healthier patients, and that will pay off financially for practices.

Before purchasing a portal, make sure it has these core capabilities:

• Lab postings;
• Appointment scheduling;
• Bill paying;
• Patient medication lists, allergy lists, problem lists, and demographic information;
• Prescription refill requests; and
• Secure messaging.

It's also a smart idea to look for a portal that's "tethered to" or "integrated with" an EHR, says Philadelphia-based Joseph Kim, a non-practicing internist, founder of several health IT websites. That way, information entered into the portal by the patient is easily validated in the electronic record by the physician, and vice versa, says Kim, who is also president of MCM Education, which develops certified CME activities.

An integrated portal could also help you satisfy some of the meaningful use criteria, such as providing a clinical summary of each visit to at least 50 percent of your patients within three business days. If a portal is integrated with your EHR, you might be able to arrange to automatically transmit that visit summary to the portal, and therefore, to the patient.

The tiny tech trend

Smartphones and tablets are two small tech-tools that are becoming big in health IT. Murthy, who calls her smartphone her "mini-office," says she uses it "all the time" for work purposes. She reviews transcribed messages on the phone, accesses a variety of mobile apps, securely views her e-mail, and reviews her calendar. The only drawback, she says, is that she can't use it to access her EHR. "I would love for our EHR to get an Android app," she says. "I believe they're working on it."

While Murthy is an avid user of her smartphone for work-related activities, her tablet is another story. "It still doesn't have the EHR app for it but more than that, it's not exactly a very good [data-] entry device," she says.{C}

That's a problem for tablets and smartphones: They're great for content consumption but not for content creation. But Joseph Kim, a nonpracticing internist and founder of several health IT websites, expects that to change in coming years as manufacturers build new devices.

If you are considering purchasing a tablet and you hope to use it to connect with your EHR, keep in mind that tablets run on different operating systems than desktop computers and some EHRs aren't compatible with all tablets. Those that are, however, are great tech tools, says Shapiro, who began using such a tablet in early 2012. "It's very easily utilized and it makes the entire [EHR implementation] process a little bit easier," he says. Think about information security, too, since mobile devices like iPads are tempting targets for theft and are easy to leave behind in cabs and coffee shops.

The telehealth trend

While mobile gadgets allow easier access to information; telemedicine technology allows physicians easier access their colleagues and patients. "We're really just beginning to see the benefits of [telehealth]," says Mertens, noting that hospitals are using e-visits to treat patients in rural locations.

But as new models of care develop, use of telehealth as a valuable means of healthcare delivery will continue to expand. E-visits and remote health monitoring, for instance, will help physicians participating in patient-centered medical homes better manage patients, and physician-to-physician videoconferencing will enable physicians participating in ACOs to more highly coordinate patient care.

"With the accessibility today of the Internet and the fact that most doctors offices are online in some way, shape, or form, [telehealth] is a great way to access and speak with other physicians; it's also a great way for patients to interact with their physicians - and it saves a lot of time and effort," says Shapiro, who has used video-conferencing as a means to educate both physician colleagues and patients about healthcare issues.

Still, many payers are not yet reimbursing for telehealth-related services. And until they do so, most physicians and health systems will continue to proceed slowly.

Murthy, for instance, attempted to videoconference with patients a few years ago but stopped because, "It never really caught on with the patients, mostly because of insurance restrictions and payment issues."

Despite the reimbursement issues, physicians should begin exploring and learning more about telehealth possibilities, says Mertens. When and if reimbursement catches on more fully, the physicians who are already comfortable and familiar with it will "be able to take advantage of it with their patients more efficiently," he says.

Tech's effects

The final big trend: the financial side effects on practices of all this new tech gear. Those practices that have not yet made the big investment, an EHR, should expect to spend pretty heavily in the next few years, and our Technology Survey indicates that they do. The good news: Only about one in four practices are in that situation, according to our data.

If your practice has already acquired major pieces of technology, you should budget about the same amount for technology as it did in typical years past, says family physician Steven Waldren, director of the American Academy of Family Physician's Center for Health IT. Technology will be cheaper, he says, but there will also be more options to consider. And he says, expect to "get more out of the money" spent on technology, as capabilities will continue to expand and develop.{C}

What technology is right for you? Just ask.

A growing number of physician-centric and physician-specific Internet communities provide a place for physicians to share information with colleagues and discuss what's working for them. Before purchasing your next tech tool, try one of them out and see what your fellow physicians have to say, says Philadelphia-based Joseph Kim, a nonpracticing internist and founder of several health IT websites. Here are four sites to consider checking out:

• Sermo

• Doximity

• QuantiaMD

• LinkedIn Physicians Practice Group

• Top 12 Apps: For a list of the mobile apps recommended by physicians for physicians, visit http://bit.ly/12-apps.

In Summary

Which trending tech tools are worth considering?

• EHRs. If federal incentives and ease of access to patient records are not enough to convince you to acquire an EHR, consider this: Not having one could result in reduced reimbursement.

•Patient portals. Portals, which allow patients to do a variety of things online securely, increase efficiency and patient engagement.

• Smartphones and tablets. These tools help keep physicians connected and informed on the go. But keep in mind they are not so great for content creation and don't connect to certain EHRs.

• Telehealth. As new models of care develop, e-visits and videoconferencing will be great tools for physicians. Start exploring them but keep in mind that many payers are not yet reimbursing for such services.

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

This article originally appeared in the July/August 2012 issue of Physicians Practice.