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Mark Anderson 3/7/09

March 6, 2009 News 4 Comments

Beware, the ICE Age Is Coming

The EHR industry has been claiming great implementation successes for the past five years. When you ask the various vendors, “How many successful EHR implementations have you done?" the answer would amaze even the most skeptical person– however, in the wrong way.

Based on data obtained in the 2008 AC Group survey, the top 100 EHR vendors claim they have more than 300,000 physicians using an EHR today. This is almost too good to believe — and for good reason. According to a New England Journal of Medicine article dated July 3, 2008[1], “only 4% of physicians reported having an extensive, fully functional electronic records system, and 13% reported having a basic system”.

This means that after 20 years of EHR adoption, less than 30,000 providers are using the full capability of an EHR, and an additional 90,000 are using partial EHR. So what does this mean for the entire medical community?

Basically, the EHR industry has FAILED miserably. The main question everyone should be asking is, “Why after 20+ years do we only have 4% of physicians using fully operational EHRs?” The answer is usually, “Cost is a factor”.

However, we do not believe cost is really the factor for low adoption. In fact, some EHR products are provided free of charge or at a highly subsidized rate. Even these products have not been implemented in masses.

So what is the real problem with EHR adoption? The main reason we hear is that EHRs slow the physician down. One reason: there is no information in the product when it goes live.

To help resolve this issue, AC Group has coined a new term, Integrated Community EHRs (ICE). ICE products are designed for community systems, including hospitals, MSOs, and IPAs where there is a desire to create a community-integrated patient record no matter where the patient is treated. These products may have full EHR or EMR-Lite functionality.

A true ICE product must provide and maintain a community health record via a community clinical and demographic data exchange.  Advanced functionality includes reporting and tracking of orders, results, e-Rx, allergies, and problem lists, among others. The product must provide a community master patient index based on numerous inputs, including hospitals, health plans, and numerous physician practice management systems.

ICE products have the abilitye  into interface with multiple EHR vendors following the national CDA standard. With changes in the Stark laws, hospitals and other community initiatives are interested in viewing ICE applications.

Under a community model, ICE product allows multiple practices to share information regarding the patient, even though the practices may have different EHR products. To insure an effective community EHR, the product of choice must have the following capabilities:

  • Community master patient index (MPI) for retrieving patient and insurance demographics.
  • One interface between all third-party companies (LabCorp, Quest, PACS, hospitals) while allowing the sharing of interface costs between all practices.
  • Patient demographics information where an address change can update each practice’s database.
  • Patient insurance information shared between all practice’s databases.
  • Patient family, social and medical history can be updated by one provider or by the patient. The information can be updated as discrete data into a practice’s EHR with one click.
  • Potential for centralized billing and accounts receivable with multiple tax IDs.
  • Reporting as individual databases and the ability to report clinical data over the entire community.
  • Referral tracking between multiple tax IDs.
  • Community patient portal, community physician portal, and community registry reporting.
  • Allows practice to leave the community and remove their database without adversely affecting the community EHR repository.

Benefits of an ICE Age strategy:

  • Data is entered once and can populate multiple databases.
  • The patient has complete control over disseminating data following HIPAA rules.
  • Duplicate data entry is reduced by 92%.
  • Overall data entry time is reduced by 74%.
  • Clinical testing is reduced by 19%.
  • Referral tracking activities are reduced by 32%.
  • Uncompensated ER costs are reduced by as much as $500,000 for every 20,000 emergency room visits. A study conducted by AC Group on 3,120 ER visits determined that if clinical data was available to the ER physician at the time of treatment, the ED physician could properly treat the patient faster and with fewer tests. Patient time in the ED was decreased by 26%. Test costs were reduced by 31%.

In summary, to enhance EHR adoption, we need to move to a new model where clinical data is shared between physicians who are treating the same patient. With community governance and security rules and regulations, an Integrated Community EHR can enhance the use of EHRs and finally drive true ROI.

[1] – N Engl J Med 2008:349:50-60



Mark Anderson is CEO and healthcare IT futurist with AC Group, Inc.

Comments 4
  • I agree that this is the natural next step in the evolution of health IT in ambulatory care.

    It is worth pointing out that much of what Mark is suggesting has been covered by the “profiles” (implementation guides) created and tested by the Integrating the Healthcare Enterprise (IHE) collaborative, and a good portion of that is on the current requirements list for 2009 CCHIT certification for ambulatory EHR systems.

  • Good point, Dr. Karamazov…er, Herzentrube. I suppose the difference between this as a “natural next step” (and I agree, it is) and standards or guides is whether anyone has yet taken the step, is following any of the guides, or is putting the abilities required by the standards to any good use.

  • To succeed, the ICE model and its component EHR products will finally need to leap forward from mere technical (data transmission) interoperability standards to a number of semantic and workflow standards.

    Mr. Anderson,

    For clinical data in EHRs, PHRs and HIEs, the biggest unmet physician need involves the reporting of diagnostic test results as fragmented data in variable formats, an antiquated vestige of the mainframe era. Slowing the physician down this way is an important factor in reported low ambulatory EHR adoption rates and implementation failure rates of 30-40%.

    Leveraging the proven power of clinical data integration and standardization can provide the simple, durable and usability-enhancing solution for all interoperable EHR and portal networks.

    Not being able to share lifetime cumulative patient test results within healthcare enterprises and between physicians in the same clinically logical way has always been wasteful and irrational. Within a true ICE product, it would also be foolish.

  • Really Mr. Anderson. This is IHE and CCHIT in a nut shell. It is difficult to to listen to a consultant that recommended Acermed to his clients. It was like recommending your clients to purchase Bear Stern. Silly Man

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