Curbside Consult with Dr. Jayne 9/19/11

The American Medical Association recently released its 2010-2011 Health Care Trends Report, which includes a new chapter on science and technology. The report is produced by the AMA’s Council on Long Range Planning and Development and additional segments will be posted throughout the year. There were quite a few interesting factoids from the Science and Technology in Medicine section.

Various studies showed higher quality ratings for hospitals with EHR and CPOE. Regardless of whether people believe that EHRs improve patient care or not, the data is interesting (or at least seemed interesting at the time, with a nice glass of wine on a crisp fall evening.)

The count of health information exchanges is now at over 200.

The AMA has decided to play Dictionary and call out the difference between an EMR and EHR:

An EMR is the legal record that is created in hospitals and ambulatory environments that is the source of data for the EHR. At a minimum, EMR systems merely replicate the aspects of paper charting and may not be interoperable (even with other EMRs) outside of the originating institution. The term EHR implies a level of interoperability with other EMRs. EHRs are essentially EMRs with the capacity for greater electronic exchange; that is, they may be able to follow patients from practice to practice and allow for activities such as data exchange and messaging between physicians.

This is interesting, as many vendors use the terms interchangeably. I’m not sure the industry would agree with AMA’s definition.

MGMA information on EHR adoption was also included in the report. One element was a bit puzzling. Of practices surveyed, “slightly more than five percent used a document information management system to scan paper records and charts and to file those images electronically.”

Really? What are the rest of people doing with their paper? Even the best EHR doesn’t eliminate paper. There’s always something coming in from a non-electronic consultant, a school, or the ever-present transfer of records.

I can’t imagine that 95% of practices don’t have a way of handling that data in a chartless fashion. On the AAFP survey, a high number of responses had to be excluded because physicians didn’t know the name of their system or named a practice management system instead. I’m betting that respondents either don’t know that they use a document management system or that the question was worded in such a way as to exclude integrated imaging components.

CPOE, clinical decision support, and e-prescribing were also mentioned, but most of the data cited fall into the “old news” category. Much more interesting was the “barriers to health IT adoption” section, which cited cost concerns for small practices, information security, etc.

Work force planning notes a projected shortage of 50,000 health IT staffers needed to support EHR adoption over the next five years. CIOs worry that staffing issues may impair the ability to achieve Meaningful Use and other bonuses. CIOS are particularly concerned about the ability to hire staff with the right skill set to implement clinical applications.

From personal experience, this is all too true. I see too many groups (vendors, health systems, you name it) who believe that that hiring college grads with no healthcare experience, no IT experience, or frankly no experience at all is the answer.

The idea that you can plug someone into an implementation training program and have them successfully achieving physician and practice buy-in and true practice transformation in a matter of months is laughable. Teaching them how to work with difficult users and challenging systems is almost an art, not easily learned from books but finely honed over time.

Despite the interesting data points, I opted for a second glass of wine rather than more figures and footnotes. As southern heroine Scarlett O’Hara says,  “After all… tomorrow is another day.”