Technology Survey 2011

When it comes to new technology, Steven Yucht, an emergency medicine physician in Gainesville, Fla., is a self-described "early adopter." But even he has some concerns about working with his practice's EHR.

"We are extremely high tech here, but I'm a little leery," says Yucht, one of two physicians at a seven-person practice. "One of my biggest concerns with EHRs is you start losing the patient-care experience."

More physicians are, like Yucht, embracing the use of new information technologies in their medical practices, according to the latest results of Physicians Practice's annual Technology Survey. But that embrace continues to be a gentle one, with reservations.

To view the results of the 2011 Technology Survey, view our slideshow here.

Today's reality is that practices are finding themselves in a time crunch to understand meaningful use rules, ensure their software is compliant with new procedures and regulations (such as ICD-10 codes), and keep up with HIPAA security rules and other regulatory changes.

EHRs and meaningful use: who's on board?

In the year since CMS released its Stage 1 guidelines for providers to cash in on lucrative incentives to demonstrate "meaningful use" of their EHRs, the number of practices that have adopted the technology has grown steadily.

According to the survey, 55 percent of practices have fully implemented EHRs or use a hospital- or parent company-supplied EHR, up from 48 percent last year.

Yet pockets of resistance remain: More than one-third of independent practices and 17 percent of hospital-owned practices still haven't implemented an EHR yet, nor are they in the process of implementation. And, about 7 percent of EHR-enabled practices say they have some providers who are outright refusing to use their systems. "It's like they own a car, but they're stuck in first gear," says healthcare IT consultant Marion Jenkins. "They have good intentions but then they buy [an EHR] and get frustrated."

Yet there are good reasons why so many providers may be dragging their feet.

One notable frustration comes from those practices and providers who use EHRs chosen by their hospital or corporate parent, without physician input. According to the survey, 6 percent of respondents from hospital-based practices said they were "very dissatisfied" with their EHR, compared with 3 percent of respondents from independent practices. On the other end of the spectrum, only 17 percent of respondents from hospital-based practices said they were "very satisfied" with their EHR, compared with 28 percent of respondents from independent practices. That's no surprise, since hospital-based physicians are far less likely to pick their practice's EHRs: Only 6 percent of respondents at hospital-based practices say they make technology purchasing decisions, compared with 46 percent of physicians at independent practices.

Bill McAveney, a Mineral, Va.-based pediatrician who works in a small practice owned by a larger corporate parent, says the EHR chosen by his employer is not one he would have chosen. "There are serious design flaws in it," says McAveney.

His chief complaint: The EHR is tailored around "a 50-year-old adult," offering medication dosage choices for adults only, for example, rather than the infants and young children he sees. Having to do constant calculations slows him down. "It's little bits of time and frustration that end up in the aggregate," says McAveney. "And it does have a significant effect on productivity."

Experiences like McAveney's are all too common, and should be a lesson to practice managers to include physicians in the decision-making process, says healthcare consultant Rosemarie Nelson. "Get your physicians involved," says Nelson. "They'll be happier if they get to participate."

The real cost of implementation

Did your practice spend more than $10,000 per physician to pay for EHR software?

If you answer yes, you have some company: One out of four independent practices (and 18 percent of hospital-owned practices) spent that much for software alone.

Even if your practice didn't spend that much, money is most certainly an issue - especially for smaller practices. Difficulty with meeting the cost of new technology is shaping up as one of the fundamental dividing lines between the growing number of practices that are hospital-owned and those that continue to remain independent. Cost was checked off as the most common "pressing IT problem" by independent practices (63 percent) who answered the survey. Far fewer (45 percent) hospital-owned practices checked off "cost of new technology" as their biggest IT stressor. What's more, cost is the primary barrier for a hefty 37 percent of independent practices, but for fewer than 20 percent of hospital-owned practices, that haven't purchased an EHR.

The government's $44,000 Medicare incentive (and $65,000 Medicaid incentive) for demonstrating meaningful use does offset some costs and helps to explain the upturn in EHR adoption across all practice types. Still, the combination of EHR costs, which practices must bear upfront, and a sluggish post-recession economic recovery is a burden to most practices.

To add to the financial stresses, practices that shell out for an EHR usually have had to make upgrades that they may not have originally budgeted for - on everything from compatible practice management systems to data backup systems.

Alberto Sobrado, an internal medicine physician at a five-doctor practice in North Andover, Mass., estimates his practice has invested more than $20,000 on supplemental technology that supports his practice's EHR, which the practice adopted in 2007.

"When you move into the technology world, people try to charge you more money for supportive technology," says Sobrado. "It becomes very expensive. And there's a perception that physicians are very wealthy and have big pockets."

In addition to adopting EHR technology in 2007, Sobrado's practice has had to pay thousands for everything from the service of IT consultants to high-tech, data backup-and-recovery technology. But even though physicians' tech-related costs are high, not investing in technology could push them even higher.

"Obviously, we're not doing a good enough job of telling physicians how costly it is to operate without an EHR," says Nelson. "So we do need to beat that drum a little harder."

Practices need to be reminded that procrastinating will only make them lose out on incentive money, says IT consultant Marion Jenkins.

"The smartest thing is to immediately make [an EHR] selection and work on your work flow to improve efficiencies" so you don't miss incentive money, says Jenkins, adding that even older physicians who can't type more than 30 words per minute and only have a few years left in practice have reason to implement EHRs, says Jenkins.

"It begs the question- can you sell your practice in five years with all those paper records? It's like doing home renovations. It increases the value of your practice, being able to say you have electronic records."

Technology and productivity

Technology's biggest selling point is that it improves productivity. But not all practices have had that experience. For many, technology actually has slowed work flow: New technology is often seen as a productivity drain because it takes so long to test out, and train staff to use.

Robin Smith, an administrator at Barnwell Pediatrics in South Carolina, which has had an EHR since 2004, says she's spent a lot of time shopping around for a new EHR as well as practice-management software.

"I think our biggest issue has been the interface with those two systems, so we're in the process of looking for a new product with a very good single-database application," says Smith. "We're really trying to find a product that suits our work flow. There are more choices out there now for a smaller practice, but the confusing part is trying to wade through all that and make sure the notes line up with the sheet music."

According to our technology survey, a new EHR usually improves work flow when fully implemented. But it can backfire, too, when a practice makes the wrong EHR decision, doesn't get all its doctors on board, or implements the new system poorly. For example, nearly a third of hospital-owned practices say their work flow is in worse shape because of the technology - another consequence, perhaps, of EHR purchasing decisions being made too far away from end users.

But as more practices become part of integrated delivery networks, there is a concern among healthcare experts and practices that productivity will be further impacted.

"The trend is practices becoming part of integrated delivery networks, and that could influence what happens to their EHRs," says technology consultant Bruce Kleaveland.

Mobile technology, e-mail, and other tech trends

This year saw a big jump in mobile technology adoption, namely smart phones and media tablets, with about half of respondents saying that they use such devices for their jobs. Apple's iPad tablet was released only last year, yet one in five practices already have at least one physician using it or one of the other tablets that were released even later. Today, a growing number of EHR vendors have come out with applications or systems tailored to media tablets.

Fewer than four in 10 respondents use e-mail to communicate with patients. Many practices have cited privacy concerns as a reason for their reluctance. Physicians are beginning to embrace patient portals as a safer and more robust way to communicate electronically with patients. Survey results reveal that 25 percent of hospital-owned practices and 17 percent of independent practices use interactive patient portals, which are usually embedded in EHR systems and may allow patients to do everything from request an appointment to receive test results to ask the doctor a question.{C}

Leann DiDomenico, the administrative director for solo practice Performance Pediatrics in Plymouth, Mass., says she's planning to spend her practice's EHR incentive money on a patient portal, so existing patients don't have to fill out another round of paper forms with updated information. "In terms of what's new, there's stuff I wish we could implement, like kiosks and patient portals, but the cost [has been] keeping us from doing it."

In Summary

More practices are using EHRs, mobile devices, and other technology to boost their patient outcomes and bottom lines. Here's what our survey uncovered:

• EHR adoption is growing, but cost was cited as the most common "pressing IT problem" by independent practices (63 percent) who answered the survey.

• To add to the financial stresses, practices who shell out for an EHR usually have had to make upgrades that they may not have originally budgeted for - on everything from compatible practice management systems to data backup systems.

• Another barrier to implementation: Getting everyone on board. Among those practices with EHRs, 8 percent of hospital-based practices and 7 percent of independent practices said that some providers outright refuse to switch to the practice's current EHR system.

• Patient portals and tablet computers are becoming more popular. In both cases about 20 percent of respondents are using the technologies.

Marisa Torrieri is associate editor for Physicians Practice. She can be reached at marisa.torrieri@ubm.com.

This article originally appeared in the July/August 2011 issue of Physicians Practice.