Independent Physician Groups, Electronic Medical Records (EMRs) and Hospital Executives
Hospitals are now allowed to help their independent physician groups pay for their electronic medical records (EMRs). Hospitals can pay 85% of the cost of the software and training for their independent physician groups. This is in the interest of the hospital systems because they can connect their doctors to their electronic information system thereby facilitating better informed care which is more efficient, more cost effective and higher in quality. In addition, this relationship builds trust, loyalty and provides a meaningful type of support which truly helps the independent physician groups.
“The devil is in the details”. How each hospital system handles this opportunity varies. Some hospitals will pay the complete 85% and others pay a partial amount. Some will let their doctors pick the EMR that best suits their practice and others will only pay if the physician group picks the EMR Software that the hospital has selected for their employed physician groups. We have some suggestions for these hospital systems. We believe that if hospital systems follow our suggestions, they will have much greater success bringing their doctors “on line” with EMRs and they will avoid the blame if some implementations are not successful.
Herding Kittens
There are some general observations about physician’s personalities and behavior which are generally accepted and seem to be true. It has been said that directing and controlling physician behavior is like “herding kittens” which means that we all go our own individual way even if a strong outside force is trying to get us to head in the same direction. We are intelligent, independent and opinionated. We usually think we know best (even when we don’t). These traits have important implications when a hospital system is trying to help us choose, purchase and implement an Electronic Medical Record. Hospital executives work with physicians all the time so they have a great deal of experience working with physicians. But, we believe, that the usual way of working with physicians may not be effective when it comes to EMRs selection, purchase and implementation. Hospital executives would be wise to consider this when implementing their EMR strategy with their independent groups.
EMR Projects are Different than any other Hospital Project involving Doctors
Why is the EMR project different than other projects that hospitals engage in with doctors and physician groups? It is because the Electronic Medical Record System (EMR) is the key tool we use for our patient care. The EMR impacts on everything we do for a patient in a significant and personal manner. When we see a patient, we use the EMR to check tests and reports, record the patient’s history and physical, document diagnoses, write prescriptions, write orders and determine a level of care for billing purposes. This system is unlike any other systems we use for patient care. When getting an EMR you have to get a great tool that works very well. The EMR decision is so critical that you have to make the correct decision the first time or you risk major disruption of the practice and the medical care of that practice. The only people truly qualified to make this decision are the physicians. They must have choice because “one size does not fit all”.
Choice
An article from Family Practice Management in 2005 entitled An EHR User-Satisfaction Survey: Advice from 408 Family Physicians made the point that it was critical to give physicians a choice in the systems they ended up purchasing. This is because the implementation failure rate is very high when practices purchase and install an EMR. Successful implementation rates are much higher when physicians make the final choice.
The fact that 66 percent either made the final choice of system or had significant input into the decision may mean that a majority of respondents want to believe they made a good choice even if they didn’t, but it could also mean that the more input a physician has into the decision, the more likely he or she is to be happy with the outcome.
The more physician input, the better the outcome in terms of physician satisfaction with their EMR choice. This occurred either because physicians made better decisions or because they “owned” the decision, so they made it work. Conversely, if the outcome is not good (unhappy doctors), and the physicians did not make the final decision, they will be quick to blame someone for their pain, their inconvenience and their decrease in income (if the system makes them less productive). Physicians have long memories and they take it very personally when you make their job harder and your adversely effect their bottom line.
Provider Productivity
Unhappy physicians is a bad thing for hospital executives. The only thing worse is unhappy doctors whose income has been affected in an adverse way. The subject of productivity is not being discussed much and I think it is because many EMR Systems make us less productive. They slow us down. These EMR companies don’t want to talk about productivity. This impact on productivity can be very significant in terms of gross income to the practice. In addition, a system which hurts our productivity makes our job less enjoyable and it can have an adverse effect on the quality of care we provide to our patients.
The price of the software is “not really the issue”, says Evan Steele, CEO of SRS Soft, a product positioned as a less complex, hybrid alternative to EMRs. “The price is dwarfed by the problems [an EMR] causes the office.” If a specialist billing $750,000 per year loses just 5 percent of her productivity once she has to start monkeying around with templates or a keyboard, the EMR can cost her more than $165,000 over 5 years, Steele argues.
This is a very conservative estimate and the costs over 5 years can be much higher. The hospital’s primary concern should be the productivity and the satisfaction of their physicians. Physician satisfaction and productivity is directly related to the EMR’s “Usability”. What is Usability and why is it so important?
Usability
Usability, as defined by NIST and ISO as “the effectiveness, efficiency, and satisfaction with which the intended users can achieve their tasks in the intended context of product use”. We need to be able to document a progress note, check labs, test and reports, write prescriptions, write orders, chose diagnostic and billing codes, in real time, when we are seeing the patients at the point of care. This is a “Usable EMR”. EMRs that are “Usable” help us get our job done efficiently and effectively. Usable EMRs make us more productive and enhance our job satisfaction. Usable EMRs help us provider better medical care and enhance the physician-patient relationship.
Who is to Blame
When doctors are not happy with their EMR system, hospital administrators had better hope that the doctors made the final decision to get the system. If they were not the decision maker, they will be upset and frustrated. They will take this out of the hospital administrator who did make this decision. This will not be a pleasant position to be in.
Our Recommendations
We have the following recommendations for hospital systems, their executives and their physician advisors. Our first recommendation is to give physicians a choice of EMR systems which are excellent but different. For example, some systems use drop down menus and pick lists while others emphasize free text, dictation or scanning a written note. Some systems are complex and expensive with “all the bells and whistles” while others have great core functionality but are simpler to use, easier to learn and less expensive. Our second recommendation is to make sure you provide a health information exchange platform so meaningful information can be shared between providers, the hospital, labs, x-ray facilities, ambulatory care centers and long-term care facilities. The connectivity should accommodate many different EMR systems. Finally, advise, support and encourage your doctor’s decisions but do not push to hard or lead too strongly. Monitor their satisfaction with their various EMRs and be prepared to promote the best EMRs (based on their feedback) to physicians new to the process or looking to change their current EMR system.
Summary
Working with physicians on EMR projects can be a minefield full of traps and challenges because EMRs are so central to what doctors do each day. The EMR has the potential to improve the quality of care we provide and make our jobs more enjoyable. It can also interfere with good patient care and make our days longer and more difficult. Physicians are opinioned and independent. Since the EMR is so central to what we do, and can have such a significant impact of the quality of care we deliver, the quality of our job satisfaction and the quality of our lives, we must be given choices so we can make the best choices for our practices. This will force us to take responsibility for the success or failure of our choices. Giving us choice will improve the chances of success with EMR implementation and it will keep the hospital’s relationship with its independent physicians strong and productive. Everyone wins when choice, utility and productivity are the primary focus of the physicians and hospital executives when it comes to EMR selection.