The Elephant in the Room

The search for the perfect EMR involves an extensive list of criteria related to features and functions, cost, hardware requirements, certification, references—and since February, the potential to obtain government incentive money. Search committees are assembled, consultants are engaged, RFPs are solicited, presentations are made, and references are checked. But there is a big elephant in the room that everyone is ignoring—physician productivity.

The effects of productivity are enormous. Changes in physician productivity dramatically and directly impact the practice’s bottom line. You can calculate the cost for yourself using the Productivity Calculator discussed in a prior blog. Physician productivity has broader societal impacts as well. Decreased productivity means fewer patients seen in the face of higher demand for care by aging baby boomers and the massive numbers of newly insured patients under proposed health care reform legislation. This is further compounded by the shortage of physicians.

Why is no one looking at productivity? Why aren’t physicians and medical societies insisting that productivity information be made available and be the focus of the EMR selection process? Why do RFPs—typically written by consultants—contain no questions about productivity? CCHIT certification has never included any evaluation of productivity, and neither does the government’s “meaningful use” matrix. Even at the recent MGMA Annual Conference there was no mention of productivity in a session on implementing EHR technology. A reasonable explanation might be that objective information about comparative productivity is not available. However, this problem could be remedied by EMR Reform—but that proposal is meeting with resistance within the industry.

Some of the answers to the questions above are less surprising than others. I believe that vendors are afraid of what comparative benchmarking would reveal about their products’ performance under close scrutiny of productivity. It is not in the vendors’ interest to yield control of the EMR evaluation process—not when scripted presentations permit skirting the productivity issue entirely. Consultants don’t feel confident that they have the tools to effectively compare productivity, particularly if vendors are not supportive of productivity measurement. What confounds me, however, is the lack of concern being expressed by physicians and their representative professional groups. I can only assume that it is due to the fear-based marketing efforts to which they are being subjected. Physicians are being told that they must buy an EMR because the government requires it and because everyone else will buy one—neither of which is true. What physicians should be fearful of is the loss of productivity that they will suffer if they do not consider productivity as a primary factor in the EMR selection process.

At next week’s HIT Policy Committee meeting, defining “meaningful use” for specialists will be a primary agenda item. We will advocate that meeting the government’s goals for widespread EHR adoption requires that physician productivity—the elephant in the room—be addressed.

5 thoughts on “The Elephant in the Room

  1. Physician Productivity is the key!
    I demoed SRSsoft and it is an excellent system.
    Even though they are a Document Based System Scanning System, they capture all the critical information in a granular manner using their prescription writing module and their order entry and tracking module.

    You have to do a demo to understand how it works, but it is very ingenious.

  2. Dr. Epstein,
    Thanks for the complimentary comments about SRS. Although our EMR did start as a document management system 12 years ago, it has evolved since then to its current status as a productivity-focused, robust EMR through the devotion of significant development resources. In addition to the two capabilities you mentioned—ePrescribing and order management—it also incorporates data capture and reporting, lab management, robust messaging, templating as desired, facilitation of transcription through tight integration with Dragon, and an efficient clinical summary, all of which contribute to physician productivity.

  3. Just found your blog today, how refreshing. I work for another vendor in the HIT space and we are completely focused on making our solution a performance improvement tool…its productivity that matters!!!

    Keep up the good work and I will be checking back with you often,

    Mike Moore

  4. Bravo! Well stated! The present state of the EMR is such that even in the hands of the most computer savy physician, he or she spends more time with the computer than the patient. Last time I looked we were treating patients, not computers. There seems to be a misconception that anything done by computer is faster and better. Sorry, last time I checked, human emotions, symptoms, and complaints are not a linear function. In the near future it appears the government will be giving a 5% penalty to those physicians who treat Medicare patients and don’t use an approved EMR. This is laughable in that physician productivity probably drops by at least 20%, i.e., seeing 20% less patients per day. It doesn’t take Quantum Mechanics to do the math here. Then, again, this may simply be consistent with federal deficit thinking. Another consideration is that when physicians, either by force or choice, spend less time than needed with a patient, they tend to order more tests to make up for what is lacking in the history or physical exam. We all know what that does to medical costs. Yes, physician productivity must be addressed! By the way, have you ever ventured a pronunciation of CCHIT. Perhaps there is some subliminal message here.

  5. Dr. Aldinger:

    Regarding the CMS penalties, they start 6 years from now in 2015 at 1% of Medicare Part B reimbursements followed by 2% in 2016 and 3% in 2017. They can reach 5% in subsequent years, but 8 years from now there will be a different administration and the penalties could very well be eliminated. Also, one can only wonder what will happen when the current administration realizes that the EMR offerings in the marketplace today are impossible implement / adopt on a national scale.

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