By Cindy Atoji
July 1, 2008 | In the journey toward electronic medical records, health care organizations continue to be concerned about two big stumbling blocks: cost and return on investment. These two persistent hurdles are compounded now by the high cost of certification, says chief executive C. Peter Waegemann of the annual TEPR (Towards the Electronic Patient Record) conference. The high rate of de-installation of EMR systems is also "outrageous" and illustrative of user dissatisfaction with many systems.
Never shy, Waegemann, who leads the Boston-based Medical Records Institute, spoke with Digital HealthCare & Productivity about the cluttered EMR landscape and what lies ahead.
DHP: You recently wrapped up the 24th annual TEPR conference. What did you hear from attendees?
Waegemann: We had a town hall session during which some people said the ONC (Office of the National Coordinator) strategy is going all right; there was an equal number who said the whole process is not working. We spent substantial time discussing government health IT spending and on rumors that McCain is not really going to spend much more than $300 million, which is a pittance; versus Obama, who has said he would invest as much as $50 billion. Besides this, there was mutual frustration expressed by physicians addressed toward EHR vendors, and EHR vendors toward physicians. There is also, of course, intense interest in what Microsoft and Google are doing, as we move away from traditional standards development and committees and toward these innovative companies. And we unveiled the TEPR cell phone project as a way of adopting and maintaining PHRs (Personal Health Records).
DHP: Your organization looks at EMR trends, including priorities for strategic IT decisions. What are you seeing?
Waegemann: Return on Investment (ROI) is still one of the key issues, because when you start doing an EMR, it will take you a little longer than paper record. Only by understanding the workflow issues and realizing that time can be saved by dealing with prescription refills, lab tests, and other issues, can one balance this out and actually save time with EMR. And that's slowly getting out into the community. But still, the challenge to the industry is to provide systems that physicians can save time on—not spend more time on.
The second part is the information capture—speech recognition capabilities have vastly improved, and users really like it now and find substantial savings. That is a big [change:] saving money through speech recognition and integrated information capture systems, which can be done through handheld units, cell phones, or systems which have very easy interoperability. This is of course, part of our push on cell phones because it is an easier way for physicians to communicate with patients.
DHP: How can we deal with the high-rate of de-installs in the industry?
Waegemann: Users are basically looking for different functions, one of which is ease of use. Consider that 80 percent of users in hospitals who are working with legacy systems—from Siemens to McKesson to Cerner and MediTech—are unhappy with their systems. No other industry has so many unhappy users out there.
We need more functionality from EMRs as well. Too many vendors are saying, "We have our system designed for all specialties." Nonsense. The moment someone says that, it's a complete lie. We need much more work in this area. Many attendees complained that the vendors have not really paid attention to all medical specialties; that there are not the templates for workflows that the specialties need.
For users who are buying systems, they are looking for transparency on the market, the same as when you buy a car or printer for your computer—you want to see what it costs, what features it has, what are the plus and minuses. Despite all the talk about certification, vendors are still not as willing to compare costs in detail as they should be. It's unthinkable and not defensible that we have leading EMR vendors who have their customers promise they won't tell someone else how much they paid for their systems. We need to get to the point where all prices are being published, all functionality is open and available, and but the vendors are not all open to sharing that information.
I personally get a calls from physicians who are tell me, "Peter, we are going to design a new EMR system, we are four doctors and have each put $50,000 in." I say, "Don't do that. With 300 systems on the market, no one should need to design a system." And they reply, "If you had to work with the system we have, you would agree there has to be a better and easier way of doing this than what is currently on the market." I hear that too often.
DHP: Workflow efficiency is a primary reason for purchasing EHRs, but isn't there a dichotomy between possible gains for large versus smaller practices?
Waegemann: It's a big myth is to say only hospitals and large institutions can benefit from EMRs. It's also outrageous that to think you should spend $78,000 for an EMR instead of $1,000. There are such a range of systems and functionality out there. If you buy the one for $70,000 or $80,000, don't think that it will be any easier to implement or that you get less de-installs. We get more complaints about the complex systems than the simple systems, and today, money shouldn't be a key issue. Some of the simpler systems can be used for a month or two for free and they cost a thousand dollars. So anyone can make the transition.
This is another thing that came out of TEPR: we shouldn't look exclusively at the electronic medical record; we should focus on the computer-based and computer-guided health care process that includes ePrescribing, electronic communications with labs, and more. The electronic medical records are only the automatic output of that process.
DHP: How do you think the certification process is going?
Waegemann: The whole certification process has hit some rocks, and let's hope the ship doesn't sink. The industry is seeing some pushback. Some are now saying being certified in 2006 is not the same as being certified in 2008. And there is also a cost issue. Some of the RHIOs and associations are pushing providers to only accept certified EMR systems. But these are the most expensive ones and this means that they are totally neglecting those that are not certified and more affordable and have almost the same functionality. And a physician should have a choice of whether they are spending $20,000 more for functions they may not even want.
DHP: What about EMR adoption—is the ONC timetable realistic? According to the latest federal health IT strategy released, the target is 40 percent of physician offices using certified EHR systems by 2012.
Waegemann: I have been looking for some real meat in the ONC strategy. A lot of it is just political smoke and mirrors. I think there has been a general consensus that we have right now about 20-22 percent of physicians who do have electronic medical records, but if you look closely at who these people are, it depends on the specialty, region and other factors. For instance, the moment you go into specialties such as surgery, you get into single digit adoption rates. If you look regionally at the East and West Coast you have substantial numbers, up to 50 percent, but then states like Mississippi again in the single digits. So it's a wide range of systems implementation. It will be a long time before we reach the goals of ONC.