Adopting EMRs: Can Challenges Be Overcome?

A recent Wall Street Journal article talks about the biggest challenges that electronic medical record (EMR) adoption faces: the physicians and HCPs using the system. One challenge that's easy to understand is finding the necessary funding -- $7.5 million of a $250 million investment is allocated for training.  Man, that is a lot of money!

Is there a better way?  We think so, but the real issue is the change that needs to occur in the training of medical personnel.  It also requires a perception change that may make the practice of medicine even less desirable today.  The WSJ article quotes one consulting firm that compares "the switch to the commercial airline industry's move from analog to digital flight decks because both involve highly skilled professionals learning a new technology quickly."  Maybe that is why the cost is so high, but does it have to be?

The Healthcare Channel (HCC) highlighted this point in one of its recent blog posts and suggested that physicians not be paid until they document moving forward. While HCC suggests in a harsh manner that it is physicians' incompetence, we think it is really a fear of the unknown.

We believe EMRs can offer significant advancement in medical care. It is clear that gaps in medical care are caused by events or issues between visits, episodes or conversations. We think technology can positively change care and as HCC suggests, accountable care organizations will need to use EMRs to achieve business objectives and margin targets.

In the end, change is often difficult. When people are faced with change or proving why they should not, most people get busy with the proof.

Getting Patients and Physicians to use EMR's & PHRs

Physicians are missing an amazing opportunity to help ensure that their patients maintain their treatment regimens. That opportunity, of course, is online. Their patients are online; many of these patients want their doctors online; but their doctors, for various reasons, continue to resist.

According to a story in FiercehealthIT, meaningful cyberspace connections aren't happening between patient and physician, regardless of the Web tool – patient portal or personal health record.

Patient portals, according to the article, are primarily used administratively, paying bills and requesting appointments. As for personal health records-–few people have them--but a survey by the California HealthCare Foundation found that more than half of those queried said they’d like a PHR provided by their doctor. Which means they want real data in their files. Which means they’d need to get it from an electronic medical record ….

A report from the business technology consultant CSC says that’s not likely to happen, because EMRs are “the least prevalent” sources of data available today.

Writes FiercehealthIT: “The common denominator between the situation with patient portals and PHRs is that most doctors and hospitals still are not making much clinical data available to patients."

A Health Affairs study might add some insight. In a national survey of physicians conducted in 2008 and 2009, 64% said they hadn’t used a patient’s electronic personal health record. The reasons: patients’ privacy concerns, data accuracy and liability issues, and lack of payment for reviewing or using the records.

Legitimate concerns, but concerns that should be worked out. These records, if maintained accurately, could lead to better health–-at least that’s what the California HealthCare Foundation found. Physicians would have more holistic pictures of their patients.

Can we all agree that would make sense?

EMRs and Pay for Performance: Stay the Course

Consider: When people must choose between changing an ingrained behavior, or proving why they don’t need to change their behavior, they will put their energies into the latter. Depending on what that behavior is will determine how much conflict there will be, and how uncomfortable the situation will get.

We fear that those who see no future in health IT or pay for performance will use lots of energy to convince others. One analysis study published in the Archives of Internal Medicine, one IT survey from Thomson Reuters/HCPlexus, and one pay for performance study published in BMJ suggest that physicians have no need to change behavior.

“Don’t spend any more money on this foolishness,” they are saying.

In our mind, is the question about the technology, or about change management?

In the Archives study, researchers from Stanford University pored over 255,402 non-hospital patient visits that occurred between 2005 and 2007 to non-federal treatment facilities. The authors looked at the role of electronic medical records (EMRs) and clinical decision support software (CDS) in assessing whether patients received better care, using 20 quality indicators as benchmarks. EMRs and CDS only exceeded one benchmark, the authors concluded.

"These results raise concerns about the ability of health information technology to fundamentally alter outpatient care quality," they wrote.

In the IT study, 3,000 MDs were queried as to whether EMRs would help patients: 39 percent said yes, 37 percent said there would be no effect, and 24 percent said the effect would be detrimental.

But could it be that some doctors aren’t tech-savvy, or that they just don’t have the time to learn how to use the system? We do not think the former, but it's true EMRs will likely,at least in the beginning, take them away from their patients. But over time, that should pass. 

Maybe it's all in the way IT is approached.An analysis study highlighted in FierceHealthIT showed that using IT, along with clinical guidelines, cut down on imaging studies for lower back and headache MRIs, and hence the costs. Yet another study in the same article noted that improvements came about when “healthcare organizations wholeheartedly embraced the technology and customized it to maximize performance.”

The operative word here: wholeheartedly.

Writes FierceHealthIT: “Physician complaints about computers detracting from patient encounters show that many doctors don't yet know how to use EHRs properly. …While today's health IT leaves much to be desired, doctors must make the effort to meet computers halfway if they expect the technology to help them improve care.”

In the BMJ pay for performance study, the researchers chose 470,725 hypertensive patients to follow between 2000 and 2007. The point: to see if their physicians could improve their patients’ numbers, earning money if they did. Nada.

“Pay for performance had no discernible effects on processes of care or on hypertension related clinical outcomes,” the authors wrote. “Generous financial incentives, as designed in the UK pay for performance policy, may not be sufficient to improve quality of care and outcomes for hypertension and other common chronic conditions.”

It’s very possible the researchers chose the wrong disease. After all, hypertension doesn’t have any initial symptoms. Patient adherence could have been an issue.

On his blog, KevinMD writes that health reformers need to “be careful about overstating the benefits” of IT and pay for performance. “The data isn’t there yet,” he says.

Our point exactly. These studies have older data. Let's see what newer data can tell us before hardline decisions are made.

The Variability of Patient Care

Back in May, Hospitals and Health Networks Magazine published an article by John Glaser, CIO of Partners Healthcare in Boston.  He is now CEO of Siemens Healthcare's Health Services unit, and a thought leader you might want to watch.  We thought this article was particularly relevant because it discussed the two types of care that EMRs need to account for, sequential care which follows certain processes and iterative care or the discovery/ diagnosis of disease.

Why is this relevant to pharma marketers?  Because industry marketers need to think differently!  They need to comprehend that electronic barriers are going to impede their product's prescribers and subsequently adoption of their product. And depending on the product, many marketers are only focusing their messaging on that iterative care piece.  But the real dollars are in the sequential care processes that follow the initial diagnosis. This we believe is where many companies and their agencies need to be focusing their message development.

We think this article begins to help marketers understand the issues going forward and offer some examples of other industries that adapt to situations.  Glaser says, "We may be able to learn from other settings in which iterative and sequential activities are occurring simultaneously —for example, soldiers in combat situations, pilots landing planes in the Hudson River and scientists conducting experiments. These settings must also balance the information technology needs and the implementation mindset."

Even Neil Versel at FierceEMR said, "Ever notice how so many examples of how EHRs can improve care focus on diabetes? That's because diabetes care has many clear protocols, copious amounts of scientific evidence that gets included in clinical decision support and clear quality measures."

Our summary point to all of this suggests, EMRs will have a tremendous impact on the future of product selection for prescription medicines and medical devices.  If you do not know a lot about this now, you may want to learn more quickly.

Mobile Health Tech Study: Get Linked

A new PricewaterhouseCoopers' Health Research Institute survey says that physicians recognize that mobile health technologies can help with patience adherence issues, physician shortages and other long-standing healthcare problems.

The results of the Healthcare unwired survey, which involved 1,000 physicians and 2,000 consumers, suggest that physicians and the public alike are ready for mobile health technologies. But PWC says various stakeholders, including some in industry, are essentially ignoring this news. The primary reason: The way the U.S. health care system makes its money. Because only in-person consults are reimbursed, the system is dependent on volume to make its money, so it is not likely to embrace the idea of reducing that volume or transferring that model to lower-cost care -- Americans feel they are entitled to the best healthcare.

According to the survey results, most physicians said they would like to receive healthcare data from their patients’ smart phones or cell phones. (Three out of 10 consumers surveyed were good with tracking it that way.) While these might not seem like big numbers, this is the start of the innovators' curve and this country will reach the tipping point. Our goal is to make our readers aware this "IS" coming and like many other changes, try not to let these opportunities slip by.

We believe that receiving such data could help with patient adherence, 88% of the physicians polled said they would want their patients to monitor certain numbers at home, especially blood sugar levels, blood pressure, and weight. Moreover, 57% of the physicians said they’d like to receive similar data from discharged patients under their care -- this lack of data is one of the biggest issues in medicine today and causes millions of dollars in inefficient care.

A few years ago, physicians, as a group, were not technologically in tune. But that has changed. In this survey, 63% said they are using personal devices to help their patients – and these devices aren’t connected to hospitals or their practices. Of those using smart phones and cell phones, 56% said the technology quickens the decision-making process, and 40% said these tools shave time spent on administration.

And time is what it’s all about: 45% of the doctors said Internet visits would allow more patient access, and 43% said mobile health technologies like e-mail and texting could reduce actual office visits. The gains, PWC says, would be huge. They could:

• help with physician shortages;

• reduce costs of hospital readmissions; and

• increase access for those patients who put off care because they won’t wait for an appointment.

The actual study (you'll need to register to get it) points out two (pharma and retail pharma) members that are tapping into this market: Bayer and CVS Caremark. Bayer has integrated its digital glucose monitor, DIDGET, into the Nintendo game console. And CVS has an iPhone app that allows members to get information on refills and other pertinent information.

Our point is that the industry needs to embrace change, especially technological change like the ubiquitous use of mobile phone technology.  

EHRs are real, but business execs may not think so

No surprises here: More than 100 IT-healthcare managers and execs, in a recent survey conducted by Embarcadero Technologies, said what worried them most about running an electronic health records system were database performance; integration of different data; and data quality. But these same executives said they are also ready for it.  

Right now, about 6% of doctors in the U.S. have Electronic Health Records (EHRs), and even fewer hospitals have them; but that’s expected to change once the new HITECH (Health Information Technology for Economic and Clinical Health) stimulus money kicks in. So why are we talking about this type of IT topic?

Because it also mentions that with more than $19 billion dollars available as part of the HITECH act, it is no surprise that close to 60% of respondents were in the process of implementing an EHR system. The HITECH Act also establishes 25 major “Meaningful Use” (MU) requirements that all electronic medical records systems must implement in order to have their users qualify for billions in government incentive money. 

So if these guys say they are ready and the dollars are behind it, why is the adoption of EHRs going so slowly?  When will we reach the tipping point? Our thought, IT professionals do not drive the business, the business people do, and they are not driving adoption of this type of "record keeping" because it is messy and complicated.  Oh, by the way, they do not have to interact with these systems to get the information they need to do their jobs, so they do not support its implementation as much as they should.  

The survey also asked these IT professionals to rank their level of agreement with areas related to “meaningful use.” Half strongly agreed or agreed that the existing information on MU and Certification and suggested their level of knowledge and technical competence was adequate to implement these systems. 

Again, this work has the potential to fundamentally change the way medicine in this country is practiced. The IT know-how is there, the money to get it started is there, so why is it not being adopted more quickly?  John Kenneth Galbraith once said, "When people are faced with change or proving why they should not change, they get busy with the proof."  We cannot help but think, all stakeholders involved with this change are kicking and screaming with their reasons to not change.  

Of course, that doesn’t mean everyone will buy the same equipment. The survey found the respondents were contracting with many vendors. Perhaps it would make sense for industry to think about vendor collaboration. Better yet, let's make all the business folks enter their healthcare data into an EHR, work with its output for several months, and then we believe adoption will grow.  

Industry will gain a good deal from the secondary use of electronic health records. Whether the information is captured at the patient level and used to help in the research and development programs or the data are gathered during a clinical trial, EHRs can help all parts of medicine, as Deloitte points out.

Google Health's PHR-Is it a sign or will they be back?

It's amusing that some bloggers are taking swipes at Google, more specifically, Google Health.  We think it’s okay for the king of the hill to get a stone in his shoe every once in a while.

Should the rumors of Google Health’s possible demise be true, isn’t it possible that Google is acting on what the rest of us suspect -- that the business model for the personal health platform needs to be reconsidered?Relying on patients to find their own way here is not proving to be the most efficient way to get patient records online.

Chilmark Research says Google Health has “struggled to be relevant.” Maybe that’s true. But if you’re not sure which way the rain is falling, it’s hard to know in which direction to hold the umbrella. 

Maybe what needs to happen at this point is for some forward-thinking group to study the models that are already out there – who’s doing them, who the patient population is, and so on – and then study the outcomes.

Maybe this is what Google Health is already doing: Retreating, regrouping, rethinking, and then planning to reissue its new personal health platform model.