>>> The study of nearly 2,000 doctors also shows they are generally satisfied or very satisfied with the EHR.

Can you give us a quote? Did they differentiate between the cheap, more usable and simple EMR vs the “significant use” EHR? This flied in the fact of the numerous studies that have reported an average of 50% failed installation rate and in one study, once implimented, there is an 8% deinstallation rate. Modern Medicine this month came out with a report that Phoenix Arizona, where the EHR was forced upon physicians, the deinstallation rate now is higher than that!

http://www.modernmedicine.com/modernmedicine/Medical+Economics/EHR-deinstallation-trend-hits-Phoenix/ArticleStandard/Article/detail/613601

>>> Another study full of positives from Physicians about EHRs, including 69% think ““stimulus money” is a big incentive to adoption.

Only time will tell what will occur with the stimulus money’s effect on the uptake of EHR. Instead of being an up-front payment, it’s structured to be a rebate, with the rules changing from month to month and with a time frame that is extremely short. History has shown that in prior PQRI demonstration projects most of those that participated came out empty handed. I believe that HITECH will fail miserably.

In an MDNG article that I recently wrote where I calculated the overall cost of significant use, I came out with a figure of $300,000.00 over 5 years, which means that the HITECH act grants are too little to really jump start EHR uptake.

http://www.hcplive.com/mdnglive/articles/PC_Medicare_HIT_mandate

>>> Also when you say things like; “The reasons that 96% of physicians despise certified electronic health records (c-EHR) systems and thus are not purchasing c-EHR are that”, you rather undercut your case.

I didn’t say that. I did quote a study that came out with the finding that only 4% of physicians are using their EHRs “significantly.” Big difference.

Don’t get me wrong. I ** like ** EMR a lot. I don’t like “enterprise” CCHIT certified bloated, I don’t like expensive EHR systems. I don’t like ARRA, I don’t like HITECH, I don’t like forced EMR use, I believe that penalties for noncompliance with EHR use short-sighted and will eventually destroy Medicare, and I don’t particularly like Obama and the idea that he is surrounded by EMR vendor lobbyists.

Heck, I have a site dedicated to EHR use including a book on how to make your own MS Office EMR!

URL: http://www.msofficeemrproject.com/

Al

RE: American Academy of Family Physicians that states 80% of Ambulatory physicians want EHR

The problems that I have with the study that you quoted are:

1) Wanting an EMR vs owning it are 2 different animals.

I *** want *** to drive a Porsche, but I simply can’t afford it. Same goes with EHRs. In fact, this point was highlighted in a recent 6/2009 Healthcare IT News survey where they found that “74 percent believing EHRs can have a positive impact on the healthcare industry overall,” but then state that “The biggest challenge to implementation cited by providers was, “lack of budget” (82 percent) followed by “lack of awareness and expertise.”

They state that:

“Fifty-nine percent of providers surveyed said they have already implemented or plan to implement EHRs in the next 12 months but only 17 percent are participating or planning to participate in a health information exchange.”

That is about right on par with the CDC study where in 2007 only 4% were using all of the features of their EHR, compatible with what many could consider “significant use” and about 23% were using EMRs.

http://www.healthcareitnews.com/news/survey-reveals-providers-doubts-about-healthcare-it-funding

2) They contacted 35,554 people, but only 5517 responded (that’s only 15.5%). I surmise that those that believe in EMR are more likely to take part in the survey as compared to those that prefer paper records. This is poor study design.

3) Unlike the CDC study that I initially posted, they do not differentiate between simple, cheap EMR use vs “enterprise” significant-use ready EHR. THAT is a big oversight. I would have been part of that 80% since I use an EMR that I programmed myself, but which is purposely NOT HITECH ready.

4) Lastly, they mention that “Fragmentation, caused by the use of hundreds of unique systems, is a major barrier to proliferation of these systems.” without stating why specifically. It does make me think of the now “thrown under the bus” CCHIT organizatoin that wanted to get rid of competition by certifying “enterprise” level EHR systems to the detriment of smaller, cheaper systems. It shows that they have an agenda and are trying to come out with data to support their position.

The following study sites two other studies, the commonwealth fund study and the American Academy of Family Physicians that states 80% of Ambulatory physicians want EHR. That’s 27% of Ambulatory doctors currently user EHRs, and the bigger groups have a rate of 57%.

http://content.healthaffairs.org/cgi/content/full/24/5/1180#R1

As I would expect “The EHR adoption gap is especially profound between large and small practices. In the Commonwealth study noted earlier, 57 percent of physicians in practices with more than fifty physicians used an EHR, compared with only 13 percent of solo practitioners, and there was a strong relationship between practice size and adoption rate”

Here another study finds while uptake has been slow, it’s not because people don’t want EHR’s’

http://medicaleconomics.modernmedicine.com/memag/article/articleDetail.jsp?id=143144

“There’s no doubt, however, that EHR adoption is growing fast. Of the doctors who say they’re using an EHR, fully half have had them for less than two years. Moreover, 23 percent of respondents say they plan to acquire an EHR within the next 12 months”

The study of nearly 2,000 doctors also shows they are generally satisfied or very satisfied with the EHR. It does break on age, with younger doctors being happier.

Another study full of positives from Physicians about EHRs, including 69% think ““stimulus money” is a big incentive to adoption.

You seem to be selecting your evidence to fit a case here.

Also when you say things like; “The reasons that 96% of physicians despise certified electronic health records (c-EHR) systems and thus are not purchasing c-EHR are that”, you rather undercut your case. It’s a very large leap from 97% (a number the study above undercuts) have not purchased EHR, to they “despise” EHR’s. Inflammatory rhetoric.

If so, who would you suggest set the bar for what “structured data” is required? Is there currently a governing body for this? If not: lets get one created.

Isn’t there a current vendor that is capturing structured data across the continuum and then providing an infrastructure where hospitals can create & share what works best, by care setting? A vendor that allows the sharing of “order sets” & protocols & best practices?

Also, I agree with all the Pro-Epic & Meditech comments. Lets be serious, there are brilliant people at other companies that are turning out rock-solid products: Epic is capturing all of the current noise – this will fade when/if other vendors start coming out with remarkable, game-changing features/products/services….it is just a matter of time. Tis the nature of America and this beautiful capitalist system we enjoy.

BUT, there were duplicate medications on the patients’ instructions and the progress notes are pregnant with useless information, designed to enable over billing, thus ripping off Medicare. They load up on information the effective clinician find useless. The list of diagnoses, active and chronic problem lists are evanescent.

What is helpful is an MAR grid with the generic and brand names of medications on the same line and lab data format that is user friendly. Unfortunately, the tops of columns on pages after page one do not have days or dates listed. Both still have too much clinically irrelevant information cluttering the fields.

In 10 years, if they try hard and heed the users, EPIC might enable safe, efficient, and cost effective care.