HIMSS: Cost, lack of data will not prevent EHR adoption
ORLANDO, FLA. -- Even though there hasn’t been any robust statistically significant relationship between adoption of EHRs and quality and efficiency among practicing physicians, it’s a no-brainer to invest in an EHR, stated Susan Dentzer, editor-in-chief Health Affairs during an educational session Feb. 21 at the 2011 Health Information Management & Systems Society (HIMSS) conference.
Citing data from the Health Information Exchange of Southern Illinois, Dentzer mentioned that the total estimate for a practice to upfront the cost of an EHR and finance the system itself is $37,000 to $58,000. But the total estimated savings in time and money for one year relating to the adoption of an EHR for the average independent practice is $14,956. Medical Economics estimated a $40,000 loss to physicians down-coding one level, she said.
Despite the fact that $44,000 is “not chicken feed” for eligible physicians to adopt and meaningfully use EHRs, and Medicaid payment bonuses can equal up to $63,750, Dentzer noted there is still reluctance among some physicians on the subject of adopting EHRs.
In 2007 and 2008, only 4 percent of physicians had a fully functional EHR, while 13 percent had a basic system, Dentzer stated. She listed the classic examples of barriers to implementation including the lack of capital resources to invest in them, concern about physicians inability to input data, lack of support from a practice’s physicians and concern about the loss of productivity.
However, Dentzer mentioned another, less considered reason: Lack of familiarity. Dentzer quoted from a January Markle Foundation survey that while 64 percent of respondents said they were "somewhat or very familiar" with the HITECH incentives and 36 percent were not very familiar, those numbers belie their true implications.
More likely, physicians are not as familiar with HITECH incentives as that survey data suggest, she remarked.
And yet physicians are in the business to improve quality, safety and efficiency, and want the ability to access charts remotely, e-prescribe, receive health maintenance reminders and get prescription refill management use out of EHRs, Dentzer stated.
But how do we get there? She noted that in programs such as Geisinger’s ProvenHealth Navigator, a physician-directed, team-delivered care model, that a system-wide EHR is crucial and the key tool to coordinate care.
And yet, 32 million Americans are estimated to ride into the realm of the recently insured on the coattails of the Patient Protection & Affordable Care Act (PPACA) in a time broadly perceived preceding a shortage of primary care physicians. So, in the face of these estimates, how can practices seek to manage the influx of insured Americans alongside adopting new technology?
Looking at bigger systems, “it’s clear to look for new models of seeing patients,” stated Dentzer. Using Kaiser Permanente’s KP HealthConnect EHR as an example, she showed through graphs that in the company’s Hawaii plan, the total patient contacts via email and telephone increased while visits decreased.
“Not everyone who thinks they need to see a doctor needs to see a doctor and not everyone needs to see the doctor in person,” said Dentzer. Some patient-physician interaction can simply be done on the phone or over an email, she said.
“Unless we learn to manage the whole enterprise differently, we are in for major, major difficulties.”
So what’s going to make a difference in EHR adoption? Dentzer remarked that she is pinning hope on regional extension centers to reach enough physicians to initiate peer-to-peer communications. Additional efforts from state health information exchanges will help educate physicians in their region on the benefits of EHRs and Beacon Communities will hopefully demonstrate results in terms of quality, safety, efficiency and population health, Dentzer stated.
The question of adopting EHRs is “when” not “if” stated Dentzer. Practices that adopt sooner can receive incentives while those that do it later could potentially incur penalties.
Concluding her presentation, Dentzer quoted Bill Gates, Jr.: “We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten.”
Assuming if the PPACA goes through and assuming that penalties kick in for not using EHRs alongside a myriad of other variables, Dentzer noted that a new generation of practicing physicians in the next decade will be brought up in a practicing environment more apt to using EHRs.
Despite some of the current attitudes of many U.S. physicians, healthcare in the future, as a result of HITECH, will be—evoking James Bond—“shaken, not stirred.”
Citing data from the Health Information Exchange of Southern Illinois, Dentzer mentioned that the total estimate for a practice to upfront the cost of an EHR and finance the system itself is $37,000 to $58,000. But the total estimated savings in time and money for one year relating to the adoption of an EHR for the average independent practice is $14,956. Medical Economics estimated a $40,000 loss to physicians down-coding one level, she said.
Despite the fact that $44,000 is “not chicken feed” for eligible physicians to adopt and meaningfully use EHRs, and Medicaid payment bonuses can equal up to $63,750, Dentzer noted there is still reluctance among some physicians on the subject of adopting EHRs.
In 2007 and 2008, only 4 percent of physicians had a fully functional EHR, while 13 percent had a basic system, Dentzer stated. She listed the classic examples of barriers to implementation including the lack of capital resources to invest in them, concern about physicians inability to input data, lack of support from a practice’s physicians and concern about the loss of productivity.
However, Dentzer mentioned another, less considered reason: Lack of familiarity. Dentzer quoted from a January Markle Foundation survey that while 64 percent of respondents said they were "somewhat or very familiar" with the HITECH incentives and 36 percent were not very familiar, those numbers belie their true implications.
More likely, physicians are not as familiar with HITECH incentives as that survey data suggest, she remarked.
And yet physicians are in the business to improve quality, safety and efficiency, and want the ability to access charts remotely, e-prescribe, receive health maintenance reminders and get prescription refill management use out of EHRs, Dentzer stated.
But how do we get there? She noted that in programs such as Geisinger’s ProvenHealth Navigator, a physician-directed, team-delivered care model, that a system-wide EHR is crucial and the key tool to coordinate care.
And yet, 32 million Americans are estimated to ride into the realm of the recently insured on the coattails of the Patient Protection & Affordable Care Act (PPACA) in a time broadly perceived preceding a shortage of primary care physicians. So, in the face of these estimates, how can practices seek to manage the influx of insured Americans alongside adopting new technology?
Looking at bigger systems, “it’s clear to look for new models of seeing patients,” stated Dentzer. Using Kaiser Permanente’s KP HealthConnect EHR as an example, she showed through graphs that in the company’s Hawaii plan, the total patient contacts via email and telephone increased while visits decreased.
“Not everyone who thinks they need to see a doctor needs to see a doctor and not everyone needs to see the doctor in person,” said Dentzer. Some patient-physician interaction can simply be done on the phone or over an email, she said.
“Unless we learn to manage the whole enterprise differently, we are in for major, major difficulties.”
So what’s going to make a difference in EHR adoption? Dentzer remarked that she is pinning hope on regional extension centers to reach enough physicians to initiate peer-to-peer communications. Additional efforts from state health information exchanges will help educate physicians in their region on the benefits of EHRs and Beacon Communities will hopefully demonstrate results in terms of quality, safety, efficiency and population health, Dentzer stated.
The question of adopting EHRs is “when” not “if” stated Dentzer. Practices that adopt sooner can receive incentives while those that do it later could potentially incur penalties.
Concluding her presentation, Dentzer quoted Bill Gates, Jr.: “We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten.”
Assuming if the PPACA goes through and assuming that penalties kick in for not using EHRs alongside a myriad of other variables, Dentzer noted that a new generation of practicing physicians in the next decade will be brought up in a practicing environment more apt to using EHRs.
Despite some of the current attitudes of many U.S. physicians, healthcare in the future, as a result of HITECH, will be—evoking James Bond—“shaken, not stirred.”