Slow Adoption Rate of EMR

This is a Getting Started resources discussing the Slow Adoption Rate of EMR.

This discussion between Robert Gleeman and Mark Anderson, CEO of the AC Group, Inc. discusses the slow adoption rate of EMR and delves into some of the reasons behind why Doctors are not using EMR as actively as they could. This interview is also provided as a written transcription below. Click the arrow to play:

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Robert Gleeman:  This is Bob Gleeman with Mark Anderson from the AC group on Casual Friday. Mark, we had talked a little bit about why more people haven't adopted EMR. You had a study that you mentioned that said something like 4% of doctors are using EMR?

Mark:  Correct, there was a study that just came out of the "New England Journal of Medicine" that actually went out and surveyed a number of physicians to find out what their EMR usage was.

They determined that about 17% of the doctors have purchased an EMR but only 4% of them were actually using the EMR in the full capacity, for actually recording, review systems, HPI, their evaluation, and actually generating a chart note out of it. 13% were using parts of the product.

After 20 years, we only got 4% of the doctors using an EMR, there's a big question out there about how valuable these systems are.

Robert:  Well first of all, do you agree with that figure, does that jive with what you've been seeing in the field as a consultant?

Mark:  Actually it does, we thought the number was closer to 7% of the doctors are actually using the full EMR. We do a lot of surveys and talk to a lot of reference sites when we're looking for vendors. A lot of references sites said: yes we had the EMR, we really like it, and our doctors are still dictating.

They classified that as a full EMR implementation. Which is OK, but the goal of all of this is to have a full EMR where the EMR generates the note, does the E &M coding. We're actually creating discrete data out of everything. We're finding reality is a lot of doctors not using all of that and not using the full capabilities of this EMRs. Now the question why are they not doing it?

Robert:  Why do you think that is?

Mark:  I think when you sit down with the physicians, we finished a new survey that shows that the average doctor spends 38 seconds charting on a returned patient. About two minutes on a new patient. The question always is, can the EMR product allow the physician to chart the complete note in 38 seconds?

The answer traditionally is "no." It's going to take a lot longer than that. The doctor are saying, if it takes me any longer, I don't want to use it. That 38 seconds goes by pretty fast when you're trying to click 500 different buttons on those EMR products today.

Robert:  Yes, yes. Now how about as far as the quality of the documentation. I've had doctors whose medical records about me were completely worthless. They didn't know what I was taking, what was wrong with me. Barely remembered ever seeing me and the notes did not help.

I know was not a one to one comparison, but what do you think is the solution to this dilemma? What is the cause and what is the solution?

Mark:  I think part of the cause still is that we have not tied financial incentives back to using the EMRs. I know Medicare CMS has a program where they're providing a little incentive for doctors using prescribing.

There's no incentive for doing all of the charting yet. I think if we can get a system... Like an EMR light product, where the doctor can at least know with what's wrong with you. They have your problem list, they have your diagnostic codes, your allergies, your lab results.

In other words, all of that important stuff about you in the chart, and they can review that. Then maybe still dictate or hand write out their note, or place all their orders on‑line. We're going to get 60% to 70% of all the business benefits that a physician needs, with a much simpler system to use today.

Therefore, allow the doctor to not become the data entry clerk for everything, maybe start walking before you run. Until someone mandates full EMRs or starts paying the Doctors for the full EMRs, then we got to come up with something that's going to work for them. Again, CMS has it, but they're only paying for e‑prescribing right now, not for the full EMR.

Robert:  What can we do at EMRUpdate to spread the word? I know what we're doing with these interviews helps a lot of people and they're discussed for years afterwards. Is there anything else EMR Update can do to further the cause of EMR?

Mark:  I think we have to get doctors and the vendors really communicating on the same level. Doctors have got to really tell people what do they really want today, versus what they may want some time in the future.

The EMR vendors have to find a way to start showing them how they can use the product today. Today may be as I need to do the whole review of systems, the HPI and everything else. Today I'd like to have information about the patient, review that information, and then have the dictated report, or the handwritten report available to me electronically. I don't have to put all of that data in.

That's got to be an option out there, and literally rarely do I ever see any vendors showing that. They spend 20 minutes show a physician can spend the next 10 minutes charting of all this information, which is nice to have. Do the doctors really want to spend the time charting all that, do they need all of that data as discrete data? Are they getting paid to do all that data entry work? Those are questions [inaudible 6:03].

Robert:  So you really see that as the major problem that the entry of the data is being done by the doctor.

Mark:  Correct.

Robert:  Would it be better if the doctor had a person like a scribe to work with them and enter into the EMR?

Mark:  Yes, if the doctor had a scribe, then they could spend more time one on one with the patient. People can enter the information in. The difference is that we're entering a lot of data in there, primarily so we can make sure that we have the right E&M code put together.

But some [inaudible 6:44] review of systems, it's kind of like everything is normal, except I have a cough, so we're going to listen to the heart.

Right now we spend maybe 30, 40, 50 seconds charting all the stuff about review of system, where it could be done in about five seconds. You can't go and say that everything is normal unless you actually looked at everything.

Again these EMRs are designed to record thousands of data elements, which is nice but most of the doctors are saying: I don't need all 12,000 of those data elements recorded. Because I don't used any of that afterwards. I'm not getting paid to do all that data entry work.

So if we can get people using I think EMR lights today. Then in 2009, 2010, 2012 progress more into full EMR capability. We got to move the number of doctors that are buying these systems from 17%, which is the estimate today, to 40, 50, 60% relatively quick. If we're going to have full EMR adoption by 2012 or 2014, we're not getting anywhere if we only 4% using it today and 17% that is bought.

Let's come up with a new model that really takes care of 80% of what the doctors need today. A product then that could meet those other 20% of the requirements sometime in the future. We all agree we need to have all this information, but right now it's not working because the doctors are not using it.

Robert:  You say they're not using it because they are the ones burdened with the entry of the data primarily.

Mark:  Well, there's a couple things that always come up. One is it's too costly, that's why I didn't purchase it. But all of the references we called that are using these vendors' products come back and say: Well yes, we liked the product but we realized the full charting took too long, so we're not using that anymore.

The interesting part is when you talk to the vendors they all say: Oh, all of our clients are using the product or 90% of our clients are fully using the product. If that was true then why are we only at 4%, based on "The New England Journal of Medicine" that are actually using it?

The reference checks we do, we find only about 7% of the total doctors are really using these systems. Especially during that first year, it takes a long time to get your templates built and do all these kind of things.

I think we need to step back now and yes, I agree we need to have the C chit stuff to determine what we're going to need in the future. But can we buy a very strong maybe C chit application that we know is going to meet the requirements of the future? Then use parts of that, in the beginning, to get physician adoption.

Let's don't give them everything. You know, make them use everything in the beginning; let's have them use certain things. Incremental approach to the EMR I think works.

Robert:  The incremental approach you have mentioned before. I think this is appealing to a lot of doctors, to start small and work your way up to make a gradual transition. As medicine always says: do things gradually, don't shock the system.

As we talk in the EMR Update, this is one of the things that comes up quite often. As you know we are primarily pro EMR, but we have a few people that are very resistant to EMR. They claim they are pro doctor and they resist.

Mark:  Right.

Robert:  Do you think that these three or four people that we have, very vocal on EMR Update, have any influence at all on the adoption rates of EMR?

Mark:  Well, I think that they are very vocal, like you say, and things. But I agree with them a lot of times, because is this really benefiting the physician themselves? We have to go back to this. This whole EMR is about the doctors using it are they getting the benefits out of it?

Most of the benefits people talk about are going to benefit the insurance companies, it may benefit the patients. In theory it's going to improve quality. But for this specific physician, is this EMR that's going to take longer for me to use, really going to benefit me enough.

I think they do, if you start with an incremental approach. Get messaging. Maybe have orders going through. But if you're going to sit there and spend five minutes recording review of systems, HPI, your full evaluation and you never use any of that data later on, does it really benefit the physician?

Or are we all doing all this data recording just so we can get the correct ENM coding, which is a financial reimbursement system. Are we really using all this data for any purpose except to just recording for some day we may need it.

I agree, orders, problem lists, basically the data that's in the CCR and now the CDA format is the biggest value. That's why I agree with a lot of the government agencies that are looking at: let's come up with a minimum data set of information that everybody can share. Why don't we just start with that?

Why don't we just start with a minimum data set that the government has set and record all of that information? But do we really need the other 98% of the data that we need to record today? We'll need it sometime in the future, but we need to get that implementation rates got to go from 17% to 50% in a short amount of time, if we're ever going to get to a full adoption rate.

At the rate we're going right now, I think we've, what, increased what 2% in the last three years? We're never going to get there growing at that rate of increase. People are selling, but not necessarily using it a lot.

Robert:  One of the topics that this seems to relate to is granularity versus text. In other words, if you take the time to check off many different points of data and increase what they call granularity, then you can use this data later and call it back. Is this what is lengthening the data entry more so than a text note?

Mark:  Yes, the text note, again a text note you can dictate a lot quicker than clicking all the buttons. Clicking all the buttons gives all this granule information. The question is what is anybody doing with all of this granule information?

Is anybody actually using that to determine anything? I think it's great to have a database with all that in, it but if you're never going to use it, what's the purpose?

Robert:  Well Mark I think you've stimulated some more heated discussion that will occur around this talk so I thank you very much for being with us again on Casual Friday. Mark Anderson, AC Group, thanks again, Mark.

Mark:  Thank you, bye, bye.

Robert:  Bye, bye.

Thanks again to Mark Anderson, AC Group for supporting our Getting Started resources for Doctors Researching EMR solutions.  

For more information about the subjects discussed here you can contact Mark Anderson at the details listed below.
See our other Getting Started resources here.

Mark R. Anderson CPHIMS, FHIMSS
CEO and Healthcare IT Futurist 
AC Group, Inc.
118 Lyndsey Drive
Montgomery, TX  77316
(c) 281-413-5572
(f)  832-550-2338
email: mra@acgroup.org
web: www.acgroup.org