As veteran readers of this blog may recall, I have published a number of previous notes pertaining to office EMRs. A physician office EMR should be designed in a different way than a hospital EMR because of different functionality requirements of the work setting. Physician offices, and even large multi-disciplinary clinics, operate under a different business model than hospitals. Vendors who lose sight of this fact do so at their own peril.
Dr. Eric Fishman is a physician who manages a business (EHRConsultant) and a web site (EHRScope) that provide comprehensive coverage of the EHR/EMR Industry and that also help physicians choose products and services related to speech recognition. He was recently interviewed in HIStalk (see: HIStalk Interviews Eric Fishman MD, President, EHRConsultant). I thought that his comments pertaining to the adoption of officer EMRs were particularly apt and I quote them below. Note the reference to "practice automation" should be interpreted as the adoption of office IT (boldface emphasis mine).
Q: What’s holding back widespread adoption of practice automation?
A: It’s a few basic issues. Physicians are the ones who pay for it, both with cash and, more importantly, blood, sweat, and tears from the angst of changing how the office functions. Third parties are the ones that benefit, like government and patients. That disequilibrium is disconcerting to many physicians.
Q. What changes would you predict in the physician office system market over the next 3-5 years?
A: There will come a time where a specialist is no longer getting referrals from their general MD because that doctor has an interoperable software program with the specialist across town. When that happens, you’ll see rapid adoption because they’ll need to stay competitive.
You’ll see greater use of non-MDs putting medical information into the history, either the patient or less highly paid people to enter the data, whether a physician assistant or nurse practitioner or medical assistant. I think that’s an inappropriate use of an MD’s time. They should be spending their time diagnosing people. It can be a substantial change of physician time to document an encounter and I think it will be attacked in different ways.
There were two takeaway points for me in Dr. Fishman's comments. The first is that office-based physicians, even those who are stakeholders in large clinics, are business owners. They will not invest capital in information technology until they can realize an attractive return on their investment. A major driver for such an ROI will come when their patient referrals become more dependent on electronic transactions.
Secondly, office IT deployment will accelerate when "practice automation" becomes more efficient, more flexible, and less expensive than the office manual practices that are being replaced. Training costs need to be factored into the total cost of ownership (TCO) of this new technology which can be substantial in an office with high employee turnover. One way to reduce the TCO of the deployment of physician office IT is by the use of physician extenders to input data into the office EMR.
In hospitals, nurses, house officers, and even staff physicians can be coerced into compliance with laborious computer input tasks despite the fact that they may be time-consuming and less efficient. In an office practice, sounder logic usually prevails regarding the adoption of inefficient work practices. Although labeled high-tech, they will usually be rejected out-of-hand.