Tech Survey: Navigating the Tech Maze

“If you implement [technology] correctly, it will make you money,” promises James Leavitt, a gastroenterologist in Miami.

That’s a big “if.”

But not too big for Leavitt’s practice. The staff there used its EMR to makeover its work flow, getting every physician on board. The result: more than a million dollars in return for the EMR investment.

Many kudos to Leavitt. Unfortunately, many physicians are worried they won’t get similar results, according to the latest Physicians Practice annual Technology Survey, with 55 percent of respondents stating cost as the most pressing technology problem. Apparently, it’s not so much what technology actually does that matters - it’s the price of technology.

This is our fifth annual Technology Survey. Some things are the same today as when we started: The debate over whether EMRs pay off remains lively. Now, though, it’s pretty clear that it’s not the software itself that makes the difference between an EMR investment that works and one that fails. What matters is how well a practice implements its new system. The process - using EMR adoption as an opportunity to retool work flow and to break some long-held inefficient habits - is what counts.

Here’s the rundown on what physicians like you are thinking about technology. Are you ahead of the curve or behind it?

Cost is king

Cost is the top concern among our respondents, outranking EMRs, billing, and communicating with patients.

In fact, the price of technologies, especially EMRs, evoked a strong reaction in our respondents. Can you hear the rage in these responses?

• “Stop ripping off physicians just because we have an MD/DO behind our names.”

• “The price of medical software is ridiculous. I think the medical industry and MDs are targets, and the general consensus is that we are poor at business but have extra money.”

• “I simply don’t see the value in office software that costs $15,000 to $20,000.

Considering the actual function of the software, these prices are simply ridiculous.” Apparently, technology vendors are joining managed-care companies on physicians’ mental list of people out to get them. It’s an emotional issue.

And yet, the majority of those who bought an EMR - which is certainly the technology du jour - report that the investment was in fact worthwhile. Sixty-nine percent found the EMR increased work flow efficiency, while 70 percent expected to see a return on investment - both promising stats.

And despite the seething comments above regarding cost, reported EMR price tags are all over the map. About a third of respondents paid between $500 and $3,000 per physician. A third paid between $3,001 and $6,000, and 33 percent paid more than $6,000 per doc for their EMR. And get this: 8 percent paid less than $500.

So you can see why it’s a bit hard to pin down what the costs, generally speaking, really are.

Anecdotally, many sense that prices are dropping. “Some companies thought doctors would pour money into it; prices have dropped,” says internist Ronald Hirsch of Signature Medical Associates, Elgin, Ill. Perry Krichmar, a noninvasive cardiologist from Pembroke Pines, Fla., agrees. “There is such a broad range of prices out there, but I think prices are coming down as competition gets more fierce,” he says.

Implement well

Even if an EMR is super cheap, of course, you won’t see any return on your investment if you don’t implement it well - that is, if you don’t change operationally or if you don’t really use the system.

And that seems to happen a lot. A troubling 17 percent of practices we surveyed have an EMR they haven’t implemented.

“I’ve known people who have paid close to seven figures who have not fully implemented the EMR,” Krichmar says. “If you are not willing to make the changes, then you are wasting your money. The pricing is not scary; it’s more scary to make the change.”

One key to success is to take control of the process yourself, instead of relying exclusively on the vendor. Only you know how you need to re-work your processes. “Usually how companies ‘implement’ you is they load the software and train you [on] how they demo the product. What you really need to look for is an implementation plan that is based around processes. That’s what a successful EMR implementation is about: improving processes and gaining efficiencies,” says Leavitt.

So are you behind?

That’s a challenge. And it may be why EMR implementation remains relatively low. Thirty-five percent of our respondents have a fully implemented EMR. But while another 21 percent say they expect to get one within the next 12 months, an equal number say they’ll never get one.

Our data on adoption exposed three big surprises:

First, EMR adoption was about the same, regardless of group size. Historically, penetration has been highest among large groups; this data suggests some evening out.

Second, recent relaxations in the Stark regulations that allow hospitals to help private practices with technology investments have had little effect thus far: Only 5 percent of our respondents have an EMR from their hospitals.

Third, for the first time in our five years of investigating healthcare technology, reported EMR use actually declined. In 2007, 39 percent of practices reported having an implemented EMR. This year, only 35 percent did. Our best explanation: Physicians are abandoning systems they implemented. Why on earth would they do that? Because they never really made proper use of the system, or the system itself failed to deliver on hoped-for cost savings.

Part of the confusion is that we’re now in the “upgrade” stage of EMR adoption. Follow-up interviews revealed that physicians who bought low-cost and low-complexity EMRs are now moving on up to more costly and more complex systems. It’s round two.

Case in point: Susan Andrews originally used the very first version of e-MDs simply to generate charts for her family practice. When the Murfreesboro, Tenn., clinic went independent, leaving the nest of a hospital-owned setup, it decided to move on to “something a little more robust with billing and a scheduler plus the EMR,” Andrews says. Now she uses Practice Partner to handle everything from charting to e-prescribing. And she got patients on the bandwagon, too. Medfusion, a Web portal that runs through Practice Partner, lets Andrews do online housecalls, and patients can type their own medical histories into their chart from home or in the office.

Krichmar had a similar experience, realizing more advantages from a system that goes beyond charting. His practice, South Florida Cardiology Associates, acquired its first EMR in 1997. “The first one was a way to cut down on transcription costs, but I never fully used it, even though it was in place eight or nine years. I was only using 25 percent of the system. I was just using it for better documentation. … If we were audited, it was there. But the only money it was saving was transcription fees; it wasn’t really making us efficient.” Now with gMed, Krichmar is much more confident that he’ll see more savings because this new system requires the practice to change how it works.

Voice recognition praised

Another handy piece of healthcare technology is voice recognition software. That’s software that transforms your voice into typed documentation. Only 18 percent of the physicians responding to our survey currently use voice recognition, but those who do use it, like it.

Given the success rate, it’s surprising that voice recognition usage isn’t growing faster. In 2006, about one in five practices used voice recognition. Last year, 19 percent of our respondents were using it. Forty-three percent said it only took them a day to get their software “trained” to recognize their voice, and 58 percent have entirely stopped using a transcription service.

Management systems need help

For all the chatter about EMRs and other documentation-related technologies, it’s practice management where the biggest growth seems ready to hit. While 37 percent of respondents installed new management software within the past two to four years, more than a third are still using systems that are five to 10 years old - a veritable geologic age for technology. Another 13 percent don’t use any management software at all.

And here’s the kicker: A full 60 percent of respondents don’t really like their practice management system. Most complain that their software doesn’t make it easy to generate reports that can help practices identify where things are going wrong. Others want a more intuitive interface or less expensive upgrades.

Other technologies used less

Given the complexity of coding, it’s interesting that only about half of all practices use technology to help select codes. Of those that do, 29 percent had revenue growth beyond 10 percent as a result. Another 20 percent also realized more cash, though less than 10 percent more.

Physician-patient e-mailing remains fairly limited as well: Thirty-four percent of practices do it, and the overwhelming majority don’t charge for it.

And while 64 percent of practices do have a Web site, only 21 percent of them use their sites to interact with patients in any way, such as scheduling an appointment or requesting a prescription refill.

Toward the future?

Reluctance in adopting technology might be expected, given physicians’ general skepticism about such things. Most have a sense that the promise is a lot bolder than reality. Here are some typical, ahem, suggestions that readers provided to vendors:

• Do not oversell your product. Be open and honest with the advantages and limitations of the specific product you are offering.

• Quit lying to us about how great your products are.

• Marketing pitches do not correlate to actual technology performance.

Ouch.

Respondents also cried out for products that really, truly provide for continuity of care from hospital to practice to the ED - products that are intuitive and user-friendly yet easy to customize.

Most products don’t seem to meet these needs, at least in our readers’ eyes. But it’s worth noting that it’s not impossible.

David Willis, a family physician, told us how he and others are making the future real down in Ocala, Fla. Willis is with Ocala West Family Medicine as well as medical director for Healthy Ocala, a health information trust. He describes Healthy Ocala as a “grassroots effort to establish a health records exchange.”

Basically, the idea is to provide one portal that lets physicians in the community tap into a patient record no matter where they are in the system. “As patients transition from inpatient to outpatient or home health or [skilled nursing facility], everything will be aggregated. If the patient has given permission, the physician can go in and see everything that has happened with that patient. We’ve seen estimates that more than 60 percent of a physician’s time is spent collecting data. This should save us a tremendous amount of time.”

Private practices can join in using any EMR. “Seeing what people go through, we know there is not a one-size-fits-all solution. We’re trying to create a model that will allow adoption at whatever rate,” says Willis.

And who pays for all of this? Well, the hospital is providing some technology, but patients and major employers will be paying too, making the model self-sustaining. An unusual model, but it points to what may be a better future for technology - one that physicians find more user-friendly and affordable.

Pamela L. Moore is editorial director for Physicians Practice. She can be reached at pmoore@physicianspractice.com.

This article originally appeared in the September 2008 issue of Physicians Practice.