Technology Survey: The Good, The Bad, and The Very Ugly

Remember the old TV show “Wide World of Sports” from the 1970s and ’80s? Who could forget that opening sequence - the one with that poor skier wiping out horrifically while Jim McKay, the legendary sports journalist, tells us solemnly that producers had been “spanning the globe” to bring you “the thrill of victory … and the agony of defeat”?

Well, we couldn’t help thinking that the results of Physicians Practice’s 2007 technology survey are kind of like that. Spanning your professional universe, our survey produced similar extremes. The numerous tales of unqualified success are accompanied by the many stories of catastrophic failure, some so bad that they’re as perversely irresistible as a car crash.

Stare at the wrecks if you like. But what’s truly important here is that the responses we received from the victors, the vanquished, and everybody in between serve as an invaluable instruction manual for you and your practice, no matter where you stand in terms of tech. There’s something for everyone, from beginners to experts, early adopters to foot-draggers.

Just like you

Before delving into the good, the bad, and the very ugly, here’s what you need to know about the survey participants. For the most part, they’re just like you. Of the 449 responses we received, 74 percent came from practices with one to five physicians. The remaining 26 percent break down as follows: practices with six to 10 doctors, 12 percent; 11 to 30 docs, 6 percent; and 31 docs or more, 7 percent.

Primary-care and multispecialty groups accounted for half of the respondents; medical and surgical specialty groups, the other half.

When it comes to EMR adoption, there is something of a divide between the “haves” and the “don’t wants.” Thirty-nine percent have a fully implemented system, and about a third are in some stage of planning, shopping, or implementing an EMR. Yet 27 percent have no plans of getting one anytime soon.

This being the third year for Physicians Practice’s tech survey, we now have some historical data for the purposes of comparison. The share reporting a fully implemented EMR has remained relatively static since 2005, hovering right around 40 percent. The proportion indicating no plans of buying one has increased every year, starting at around 21 percent and inching up to this year’s 27 percent.

The only other significant change is the share reporting having purchased but not yet fully implemented a system. That’s fallen every year, starting at 20 percent and reaching 12 percent this year.

Taken together, these trends seem to suggest that EMR adoption is flattening out, at best, and may soon wane. Several survey respondents blame their vendors for failing to help them fully exploit their EMR systems.

“It seems that, in general, those who write software really don’t seem to care about educating those of us who pay for and have to use their software,” one anonymous respondent writes, arguing that vendors should provide better instruction materials rather than insufficient training discs. “I’d love to have [a vendor’s training representative] come to my office just so I could hand them a scalpel and a ‘training disc’ and tell them to figure out how to do the surgery themselves!”

Walter G. Griffith Jr., a psychiatrist with a solo practice in the St. Petersburg, Fla., area, tells us EMR adoption was “one of the biggest challenges of my medical career and scared me to death in the beginning.” While he’s happy that all patient encounters are recorded electronically and there’s no longer a need to pull paper charts, he’s laboring to bring about additional technological advances. “Part of my problem is an inability to find dependable tech people who can solve network, hardware, and software issues.”

But these struggles pale in comparison to others. David Magier, for example, says his Long Island, N.Y., practice bought “an electronic medical records system for many thousands of dollars, and now it is totally useless and obsolete.”

Reason for hope

For those of you struggling to convince your partners to plunk down the cash for an EMR, to find the right system for your practice, or to get the darn thing you already bought to work, our survey should give you reason for optimism. Of those who have successfully taken the entire plunge, buying and implementing an EMR, an overwhelming 81 percent say it has made work flow more efficient. Just 6 percent say it has made them less efficient. Moreover, 61 percent of EMR owners were able to reduce or reassign staff. In other words, many are operating more efficiently with less staff - a disagreeable development for some employees, to be sure, but highly desirable for employers.

And while many struggle to fully implement EMR systems (26 percent), 52 percent did so in a mere month. An additional 22 percent wrapped up work in three to six months. At About Women Ob-Gyn in Woodbridge, Va., the keys to a successful implementation were timing, preparation, and strategy, says Yolanda Raffert, the practice’s administrator.
For example, About Women transitioned from paper to an EMR in stages.

The challenges now, she says, are “managing physician time to include routine training … and to keep up to date with changes and enhancements. … Everyone was very interested in the initial roll-out; however, it is challenging to keep their interest in its growth and development.”

While no implementation is effortless, scores of practices out there are worthy of emulation.

“We incorporated an EMR and practice management [software] into our practice over the last four years,” says Dan Berg, a family practitioner with Parkview Medical Clinic in New Prague, Minn. “We keep our servers on site. We are independent, and we’re making a go of it!”

Show me the price tag

OK, but what about cost?

Nearly half of respondents (48 percent) say they paid less than $500 per physician for the necessary software (hardware excluded). Not bad. You can easily spend more on a dinner for four at some restaurant named for the chef.

But here’s where it gets weird: Twenty-three percent say they spent more than $6,000 per doc. Rather provocatively, there’s not very much in between the lowest and highest price points. No $1,000 increment between $500 and $6,000 got more than 5 percent. By the way, these results are completely consistent with those of our previous tech surveys.

There are myriad explanations for the enormous disparity. Just as there are Geo Metros and Ferrari Spiders, there are economy and luxury models. Different approaches to the technology also affect pricing. Vendors can offer this stuff via a Web site, or they can come to your site and load it all onto your server.

The gargantuan price differential also results in part from industry fragmentation and product diversity, explains Nancy R. Smits, a healthcare industry consultant and president of SHR Associates in Annapolis, Md. When consolidation and standardization come about, as they inevitably will, product pricing will smooth out, she predicts. One day, EMR software may even approach commodity status, which will be good for you, perhaps less so for vendors.

Regardless, you’ll be well served by some hard-core competitive shopping. Those in the market clearly understand this. Fifty-eight percent of survey respondents say it took them (or most likely will take them) as much as three months to select an EMR. The other 42 percent expect to look around for four months to a year, maybe longer.

While shopping, keep in mind that sometimes inexpensive purchases represent bad value, while breathtakingly expensive purchases prove to be great values. If that Geo Metro breaks down every Tuesday, forcing the owner to invest tens of thousands on repairs, it’s not so inexpensive and not such a good value.

One way to objectively measure value is return on investment (ROI). The news our survey delivers on this front isn’t particularly good. For every two respondents who say they have earned back in efficiency and revenue what they invested in an EMR, three say they have not. That’s despite the large number of survey participants who were able to reduce or reassign staff. However, by a two-to-one ratio, respondents expect to see a positive ROI.

That sort of optimism may be misplaced, says Stephen Hawk, a psychiatrist with Bay Area Behavioral Health Associates in Largo, Fla. The notion that “ROI will pay for your system is largely a myth,” he says. “The reason is that [vendors] overstate the potential increase in revenue. For some practices, this is negligible.”

Hawk’s reaction is relatively common among small-practice physicians, says Charles Anastos, senior vice president with the healthcare technology consulting firm Beacon Partners. For one, many physicians expect to see a return overnight, and that’s not realistic for smaller practices, he says. “It takes some time.” At the very least, most practices need two to six months to simply become proficient with the new technology.

Second, sometimes physicians fail to take a complete overview of finances following implementation. They focus exclusively on revenue, leaving savings, which should come with a new EMR (and which can be substantial), out of the equation, he says. Finally, physicians too often keep a paper-based work flow in place after going digital, leaving many of the potential benefits on the table.

“You get what you put into it. We see lots of organizations that assume they can take their current way of doing business and just automate it,” Anastos says. “You need to look at work flow, to create efficiencies with technology.”

Despite his doubts about the potential for financial return, Hawk is a strong advocate for EMR adoption. “The reward ultimately seems worth it, not in ROI but in intangible ways such as better documentation, much better risk management, patients’ perception that you are ‘keeping up’ with the times, and decreasing my labor of writing the same [prescription] over and over.”

Can you hear me now?

Enough about EMRs. What about all the other gadgets and gizmos purported to make your work lives easier?

Our survey revealed that few of you and your peers (19 percent) are using a voice recognition product. But abstainers might want to reconsider. Every respondent who is using such a product says it generates cost savings. What’s more, it’s easy. Eighty-four percent say they got the hang of voice recognition in less than six hours.

More practices are using some type of coding software, we found, but not yet a majority (43 percent are; 54 percent aren’t). Again, those on the outside looking in might want to find the door as 77 percent of users say it resulted in revenue growth.

As for practice management software, all respondents have it and use it. What’s interesting here is how long they’ve had the software they’re currently using. Thirty-eight percent have had it for a year or less, while 10 percent have had it for more than a decade.

The remainder falls in between. Of all users, regardless of when they bought their current software, 56 percent say their product doesn’t do all that they want it to do. The overwhelming majority of these respondents want better reporting (65 percent). Users are also looking for better integration (15 percent) and more intuitive interface (10 percent).

And then there’s e-mail. How many of your peers use e-mail to communicate with patients? Our survey says 30 percent. Almost none of those who do, however, have monetized e-mail exchanges. Ninety-eight percent say they don’t charge patients for the privilege to communicate with them via e-mail.

This doesn’t mean physicians are Luddites. Fifty-nine percent say their practice has a Web site. However, just 5 percent of the sites are interactive, meaning patients can use them to make appointments, check on lab results, or ask a question. The rest are just static, informational sites about the practice, office hours, and staff.

Interactivity may be beyond what most practices are ready for, given the low awareness of security issues. When asked, “How sure are you that your electronic records, e-mailed communications, electronic claims, and other digital patient information is secure from hackers?” 21 percent answered, “Electronic what?” An additional 36 percent are not at all sure or just somewhat sure.

Considering the number of BlackBerrys and Palms we see, from the highways and office hallways to the treadmills and restaurant tables, it came as a great surprise that only 24 percent of you report using a personal digital assistant to communicate with your office and family. You know, we’ve come a long way since the carrier pigeon.

What’s next?

So with all of these offerings, and with all of the varying levels of technological proficiency among physicians, what are the most pressing IT problems among your peers? This open-ended query generated a gaggle of answers more diverse than the United Nations, although many are related in some way to the EMR.

“Finding an EMR that lets me continue to practice in the manner that I choose,” one person says.

“There are no standard leaders in medical software as in many other industries,” says another. “There are too many variations and vendors. The interfaces are proprietary rather than open. It is difficult to spend that much money, knowing that the support in the future may be limited and that there may eventually be a standardized software out there.”

“Not being compensated for the added investment” of an EMR, yet another respondent allows.

The pace of technological progress also causes consternation among physicians, as many say their primary problem is simply keeping up with it all. “The biggest challenge is to continue to move forward with changes rather than stopping with current progress,” one survey participant asserts.

If your IT problems seem more prosaic than those mentioned, you’re not alone: Among the more commonplace answers: “Believe it or not, the phone system” is the most pressing problem. “Paying off IT debt.” “Who can remember all the passwords? And everyone has a completely different method of navigating around their systems.” Finally, the most direct answer of all: “Cost and time.”

Mark R. Cheshire is managing editor of Physicians Practice. A graduate of the Columbia University Graduate School of Journalism, he has 15 years of journalism experience. He can be reached at 443 543 5120 or via mcheshire@physicianspractice.com.

This article originally appeared in the September 2007 issue of Physicians Practice.