Study dissects the motivations behind EHR implementation

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The Medical Records Institute (MRI) unveiled the results of its 8th Annual Survey of EHR Trends and Usage 2006. The MRI’s main motivation in doing the yearly survey is to a gain a sense of where the market is and what is going on, as well as perceived barriers, said C. Peter Waegemann, CEO, this week at the 7th Annual Health IT Trends & Marketing 2006 Conference in Cambridge, MA.
The survey was conducted from April-June of this year and includes feedback from 729 participants who responded online or at this year’s TEPR (Towards the Electronic Patient Record) conference in May. Nearly 47 percent of respondents work in the ambulatory space, 25.2 percent from hospitals, and 21.9 percent from IHDSO (integrated health delivery service organization), with the rest working within healthcare but not directly in IT, said Waegemann.
Additionally, the survey grouped the respondents’ job roles as follows: IT managers and professional (35 percent), physicians and nurses (28.5 percent), non-IT management (18.1 percent), and 18.4 percent were executives. Generally, these are
“people who are heavily influencing” the purchase of these systems, said Waegemann, adding that nearly 90 percent of respondents reside in the United States.

Of the primary reasons why respondents from hospitals implemented EHRs, 57.8 percent claim to have been driven primarily to implement an EHR for efficiency and convenience gains; 42.4 percent sought to satisfy the needs of physicians and clinicians; 41 percent cited rising competition from other healthcare facilities; regulatory requirements such as JCAHO and NCQA (35.6 percent); and saving money spent on medical record departments and transcription services (24 percent).
For medical practices, top motivations were efficiency and convenience to physicians (81.7 percent); savings and increased revenue through improved coding and charge capture (60 percent) – which Waegemann indicated was somewhat of a mysterious result because the industry does “not have a universal way of describing what charge capture is”; satisfaction of patients and physicians (52.6 percent); and the need to compete (44.4 percent).
From the opposite view, a key barrier to implementation is a lack of adequate funding (58.5 percent) — which means that this amount of people cannot find the business reason for implementation, though it means that 42 percent can, said Waegemann. Other barriers include a lack of support from medical staff (35.4 percent); a lack of affordable options (31. 7 percent); difficulty in evaluating the systems (24.9 percent) — which the HHS is trying to aid with its new certification process; not able to find an EHR that meets their clinical needs (22.9 percent); concern over systems that are fragmented over multiple vendors (29.7 percent); and perceived difficulty in building a good migration plan (31.2 percent). Waegemann said his belief is that the industry should develop a standard EHR migration model to ease this process.
Asked how they enter clinical information into their EHR, for free text and/or unstructured data entry, they primarily use keyboard and mouse (53.5 percent), though also commonly use dictation/transcription without speech recognition (38.3 percent), and use stylus with Tablet PC and PDA less frequently (28.3 percent). For structured data entry, respondents primarily use keyboard and mouse (53.5 percent). And as for document scanning, the most commonly used method is input from other departmental systems within an institution (34.6 percent).
The survey sought to get any understanding of what types of applications facilities are commonly using now, or hope to use in the future. Billing and accounts receivable (57.3 percent) came in on top for this category, followed by scheduling (56.4 percent), patient appointments (55.4 percent), claims processing (53.9 percent), and registration/admissions/discharge/transfer (52.4 percent).
Regarding automated EHR data capture in use today – which is reportedly in use at 60 percent of respondent facilities -- Waegemann said, “most people would say, ‘how can it be that in 2006 only 60 percent of providers have automated patient data capture’,” he said, which could be explained by discrepancies regarding how this is defined.
The seemingly low number for data capture seemed to open up a can of worms filled with disappointments, with EHR data capture, review, and updates capture all showing implementation rates generally lower than last year. This, Waegemann claimed, likely “went down in some ways due to the larger number of participants.”
Also disappointing was usage of order entry applications in hospitals settings which Waegemann described as having “lots of room for improvement.” The study found that for nurse or staff order entry just 26.9 percent of respondents are using it in a laboratory setting, with radiology (25.1 percent) and pharmacy (23.6 percent) coming in slightly lower. Physicians use it even less, with 14.3 percent using it in lab settings, and fewer in radiology (12.5 percent) and pharmacy (11.9 percent) using it.