DOCtalk by Dr. Gregg 6/18/14

Change is Gonna Come

A 40-something-year-old friend of mine was in the office the other day, unhappy about his current work status. He’s a manager at the local branch of a very large national bank. He’s pretty successful, too, with our little Nowhere, Ohio, branch consistently ranked number two in the state by those who do the ranking at the mothership bank. Thus, it was pretty surprising to hear him bemoan his current sense of job insecurity.

“They’re really getting harsh,” he started. “They’ve instituted all these new metrics that, if we don’t meet them, and do so consistently, we’ll get canned.” He described the measures and how demerits are accrued, but that’s less relevant than his summation: “The whole industry is trying to cut losses. That means getting rid of staff. Our bank is cutting personnel like crazy. They’re taking the savings to invest in technology. They don’t think the upcoming generation will need many bankers, as they are so inclined to address their banking needs via technology. Less employees to pay, more tech to buy.”

This harsh reality of the impact of technology upon the workforce of an entire industry should be a clear wake up call to those of us in the healthcare domain: Technology is a boon, but can be a double-edged sword.

My friend’s comments reminded me of an article I read a while back in The Health Care Blog where Vinod Khosla, (in)famous co-founder of Sun Microsystems, pulled out his crystal ball and dished some prognostications about the future of healthcare at the 2012 Rock Health Summit in San Francisco. The article’s title is what stuck in my head: Vinod Khosla: Technology Will Replace 80 Percent of Docs.

While Mr. Khosla’s view may have been a bit over the top – and many pundits did roundly criticize his comments, I’d argue that there’s more of a “there” there than not. Lots of devices are now in development, and some are already available, to make self-diagnostics more common and accurate. It may be a little while before you have a complete “home doc in an app,” but you can see small steps in that direction all over the place. The highly priced skills of a doctor are not immune to usurpation.

Highly skilled specialists and surgical types may have longer to “live” than primary care providers because it’s the bread and butter stuff of primary care that is most easily “technologized.” Simple afflictions and easily diagnosed problems are ripe for mobile tools and apps to steal away some of that bread and butter.

But, there’s another critical element in primary care for which I don’t think you’ll find an app anytime soon – the human element. From seeing patients as real, whole people and not just a list of problems or set of conjoined organ systems to the value of therapeutic touch to the whole doctor-patient interpersonal relationship thing, real people can provide a healing power far beyond any drug or procedure or set of prescribed palliative placebos or protocols. Call it “person power” or whatever you like, but people still have a poorly understood but powerful impact upon each other, to a degree that no device or app has yet been able to accomplish.

Thus, I don’t think 80 percent of doctors are going out of business, to be replaced by techno-devices, anytime soon – at least not until we have a much, much deeper understanding of things like personal genomics and medical minutiae at the molecular level. But, I do think current providers would be wise to open our eyes to the possibilities, to the changes that such technological advances will bring, not just in helping us to help patients, but also in helping patients help themselves.

Change is gonna come, and likely sooner than the slow-moving machine that is healthcare may expect.

In the not too distant past, many folks used the banking industry as an example when discussing what could be done to digitize the industry of healthcare. Banking embraced technology much earlier and much more quickly than healthcare did. Thus, their steps along the path toward the full impact of that embrace are much further along than are ours. If we’re smart, we’ll take notice of what such change has wrought for our banker buddies and get a little proactive medicine into our systems to prepare for the future we’re creating – a future that may not include nearly so many of us in-the-trench providers.

From the trenches…

“To improve is to change; to be perfect is to change often.” – Winston Churchill

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 6/17/14

Top News

A CommonWealth Fund survey of 11 countries ranks the U.S. first in expense, yet dead last in measures of "efficiency, equity, and outcomes." The U.S. earned similar accolades in 2010, 2007, 2006, and 2004. The survey report notes that “U.S. physicians face particular difficulties receiving timely information, coordinating care, and dealing with administrative hassles. Other countries have led in the adoption of modern health information systems, but U.S. physicians and hospitals are catching up as they respond to significant financial incentives to adopt and make meaningful use of health information technology systems. …” “Catching up” may not be the most accurate phrase to use at this point, as ONC stimulus money slowly peters out, competing organizations attempt to determine the future state of interoperability, and EHR end users remain vocal about inefficient, HIT-inflicted workflows.   

Acquisitions, Funding, Business, and Stock

Franklin, TN-based Cumberland Consulting Group acquires Cipe Consulting Group, a 50-consultant, Seattle-based EHR and RCM consulting company. The acquisition marks the second in less than a year for Cumberland, which acquired Mindlance Life Sciences last November.

The viability of HIE commercial ventures is called into question with the closing of Thrive HDS, a commercial offshoot of the Indiana Health Information Exchange formed just nine months ago, which specialized in clinical data repository services and related analytics.

Announcements and Implementations

FHP Health Center (Guam) selects the eClinicalWorks EHR to help its 12 facilities transition to paperless practices, meet Meaningful Use objectives, and transition to ICD-10. While FHP’s history doesn’t go back quite as far as Kaiser Permanente’s, it’s interesting to note that the 41-year-old organization was founded as part of the island’s TakeCare HMO.

In additional eCW news, Family HealthCare Network (CA) announces new functionalities within its My Health/Mi Salud patient portal including appointment requests, prescription refills, secure messaging, and access to personal health records. The network implemented the MED3000 (now McKesson) InteGreat EHR in 2009, and received more than half a million Meaningful Use incentive dollars as a result. One can only assume FHN is well on its way to meeting Stage 2 MU objectives.

Oregon Outpatient Surgery Center launches the “Save Our Veterans” program, which offers free surgeries to local veterans, as well as free pre- and post-treatment, including medical services and supplies. The center’s offer is a timely one given that a recent national audit found that the Portland VA Medical Center had the nation’s fifth-longest wait time – an average of 80 days – for new patient primary care.

Government and Politics

ONC announces that its first Chief Privacy Officer Joy Pritts, JD has resigned after four years on the job.

The tweet above highlights what Eric Boehme, associate director of informatics at Vanderbilt University Medical Center (TN), worries is the unstable future of the Meaningful Use program: “ONC has lost a significant portion of its funding as the stimulus money dries up. Recently, some members of Congress questioned how much ONC should regulate HIT. ONC National Coordinator, Farzad Mostashari, CMS Administrator, Marilyn Tavenner, and the HSS Secretary, Kathleen Sebelius have all resigned.” Add Joy Pritts to his list and his concern becomes even more valid.

In the meantime, the American Geriatrics Association is kind enough to remind Medicare-eligible physicians that they have until July 1 to apply for Meaningful Use hardship exceptions.

The HHS Office for Civil Rights issues its annual breach report to Congress, which finds that OCR received 236 reports of breaches involving 500 or more individuals occurring in 2011, and 222 reports of large breaches occurring in 2012. Nearly 15 million individuals were affected. Top causes of these larger breaches include hacking/IT incident; theft; unauthorized access, use, or disclosure; and improper disposal.

Innovation and Research

Mr. H. and The Daily Show’s Jon Stewart may give Google Glass short shrift, but it seems to be making further inroads into mainstream medical practice nonetheless: Drchrono integrates Glass into its free EHR platform, creating what it refers to as the first “wearable health record.” The company believes that the “future of a doctor is one where they have an iPad, an iPhone, a laptop, and Glass all connected through a mobile EHR platform so they can operate efficiently and spend more one-on-one time with patients instead of processing paperwork.” This vision of a hyper-connected future sounds intriguing; you have to wonder, however, how much that prediction will play out in present day Glass use.

A new report on first-quarter recruiting data shows that physician job postings account for a majority 44 percent of all those posted, while IT-related jobs follow at 23 percent. Project management, software development, health information administrator, systems analysis, and analyst HIT showed the most growth in number of healthcare IT jobs posted year over year. Sadly, but not unexpectedly, the report also found a 49-percent career dissatisfaction rate among physicians, with the percentage even higher in the general medicine and primary care specialties.

A separate study finds that government and military employment, including the VA, is the last choice for physicians when it comes to workplaces. Private practice and hospital employment were the obvious top choices, while just 2 percent of respondents ticked the government/military box.

People 

The Ohio Association of Community Health Centers names Theodore Wymyslo, MD (Ohio Department of Health), chief medical officer, and promotes Julie DiRossi King to COO.

Other

A New York Times op-ed highlights what many in the industry are thinking: Apple’s upcoming HealthKit app may not be the game changer many digital health pundits would like it to be. The author cites several reasons, including lack of true interoperability between healthcare technologies (not to mention Apple and its new HealthKit partner Epic); a lack of interest in sharing data on the part of patients (“no one likes to be nagged”); and the fact that technology, no matter how new and shiny it may be, is only as good as the people using it. The biggest barrier to HealthKit’s success, however, may be physicians, many of whom are likely not set up to incorporate patient-generated data into the EHRs some of them already dislike.

News 6/12/14

Top News

Private physicians working in the Wesley Medical Center ER face an ultimatum that will likely become all too common as hospitals look to streamline via direct-employment relationships: Become employees of WMC’s staffing vendor, EMCare, or lose their jobs at the hospital. Mark Mosley, medical director of WMC’s emergency department, believes the hiring situation will put patients at risk: “We tried to explain to the administration the relationship we have with physicians in the community, the relationships with nurses, and the kind of patient care we give is not something you can fly in from out of town and buy. It’s created from years of teamwork. When you take that away, you potentially put patient care at risk.” The ER physicians, part of the Emergency Services Professional Association, have until September 3 to make a decision.

A  VA self-audit of 731 facilities finds that 13 percent of schedulers were told to enter desired appointment dates different from what the patient requested, eight percent of facilities kept external scheduling lists invisible to the VA’s EWL/VistA systems, and unrealistic targets encouraged facilities to game the system. New patients waited up to three months to see a doctor. The VA announced immediate changes: eliminating the 14-day appointment target as unreasonable, implementing real-time patient surveys, conducting an external audit, freezing new hires and eliminating bonuses at VA headquarters and regional offices, and creating an HR team to get clinicians hired faster. It also plans to implement a new scheduling solution to work within its VistA EHR, according to statements made by VA CIO Stephen Warren at a recent Senate hearing. Meetings with industry are scheduled for next week, and the agency hopes to have a product in place by the close of fiscal 2015.

In the mean time, the VA releases an interactive map showing average wait times for new patients. Only one facility stands out as having wait times of less than 14 days.

Acquisitions, Funding, Business, and Stock

The local paper notes that Hill Physicians Medical Group (CA) is “making bank on health reform.” The group achieved over a half billion dollars in revenue for the first time, reaching $505.2 million in 2013. HPMG attributes the revenue to cost-of-care savings associated with its participation in three ACOs that same year. Two more were added in 2014. Perhaps that “bank” will be used to fund HPMG’s investments in technology that will be used to improve the way it pays claims to doctors and to transition to ICD-10.

Napersoft announces support of EHR summary documents for patient portals, enabling patients to securely view, download, and transmit their data while helping physicians meet multiple Meaningful Use objectives. Napersoft’s CEO, Bart Carlson, was featured in a recent issue of CEOCFO magazine, where he pointed out that healthcare is one of the company’s biggest areas of opportunity.

This headline takes the cake when it comes to healthcare acronyms the average lay person probably wouldn’t understand. CECity announces that CMS has recognized 10 of its qualified clinical data registry collaboratives for reporting under the Physician Quality Reporting System.

Announcements and Implementations

The Medical Society of Northern Virginia launches the HeaLiXVA HIE that, in its first phase, will enable Fairfax Family Practice, Loudoun Medical Group, Sunrise Medical Laboratories, and Solstas/Quest Laboratories and Radiology Imaging Associates to connect. A second phase will connect local hospital systems. Physicians can subscribe to the new HIE for $25 per month, though EHR integration fees are not included. It’s somewhat refreshing to hear about a HIE just getting off the ground, when so many seem to be running out of grant money and closing up shop. 

Panhandle Orthopaedics (FL) signs on for practice and revenue cycle management services from AssuranceMD. PO’s sole physician, Michael Gilmore, MD seems especially tuned into healthcare IT, peppering his Facebook page with numerous industry-related posts.

The local paper profiles Allen Gee, MD and the virtual telemedicine practice he has established at five clinics across Wyoming. Gee, who was awarded the 2014 Vision Award from athenahealth, is in the process of opening a sixth clinic where patients will be able to check in via handheld devices.

Government and Politics

Sue Bowman, AHIMA’s senior director of coding policy and compliance, outlines top priorities healthcare organizations should focus on leading up to the new ICD-10 compliance date during recent testimony in Washington, D.C. They include:

• Increased testing internally and with payers
• Increasing engagement with physicians and their staff, ancillary departments, and post-acute providers to ensure all stakeholders are moving toward ICD-10
• Evaluating and resolving ICD-9 coding and documentation issues
• Leveraging technology to provide real-time documentation improvement tools that facilitate documentation at the point of care
• Developing a more thoughtful and comprehensive educational plan
• Analyzing data to identify and focus on high-risk documentation and coding areas

Statistics presented at Tuesday’s HIT Policy Committee meeting indicate that of EPs who first attested for Meaningful Use in 2011, 84 percent attested in 2012 and 75 percent in all three years of 2011, 2012, and 2013. Nearly half of those who attested the first year and then skipped 2012 returned in 2013. EHR incentive payments totaled $24 billion through the end of May.

People

Practice management and population health technology vendor Privia Health appoints Andrew Aronson, MD chief medical officer. Aronson will work closely with the physicians of the company’s multispecialty Privia Medical Group (VA) to improve coordinated care value and quality. Privia’s business model is an unusual one. The practice management and population health technology vendor’s clients  came together at the beginning of this year to join the Privia Health brand through the formation of PMG.

Other

Thanks to Dr. Jayne for mentioning that the call for proposals for HIMSS15 is open through June 16. As she points out, that’s nearly 10 months before the actual conference, decreasing your chances of seeing presentations that are fresh and timely. Submitters beware: A user name and password is required, and the submission website works well only with certain versions of certain browsers. Good luck!

The City of Bullard, Texas, renames a portion of Hwy. 69 as N. Doctor M Roper Pkwy, honoring 93-year-old Marjorie Roper, MD. Roper opened Bullard Medical Practice in 1947 in the back of her father’s drugstore, where she practiced medicine for 60 years.

The Patient-Centered Primary Care Collaborative releases the Primary Care Innovations and PCMH Map, which allows users to identify where medical homes are becoming a standard of care in commercial and public-sector health plans. Nearly 500 initiatives are tracked.

5 Questions with Jim Morrow, MD

Jim Morrow, MD is CEO of Morrow Family Medicine (GA), Medical Director of IntelliChart, and sits on the boards of the Georgia Health Information Network HIE and the Institute for Health Information Technology. As MFM’s only physician, he sees between 50 and 70 patients a day with the help of a PA. MFM also includes two MAs and three ancillary staff members. He has used an EHR from Allscripts since 1998.

How has healthcare IT, such as your EHR, impacted your practice? Any before and after anecdotes to share?

• Productivity: I’m able to see more patients because I do not have the time to dictate after seeing patients. I am much more efficient on EHR than without.
• Staffing: I’m able to employ fewer people due to the efficiency.
• Cost: It’s much cheaper to send messages to patients through the portal. I don’t have to involve an hourly employee in that process.
• E-prescribing: Quality increases because errors are minimized. And there are no handwriting problems.
• Quality generally: I have the ability to search lab orders and be sure that ALL labs that were ordered were resulted, as opposed to the paper world where you cannot know if a lab was just never resulted and you lost track of it.
• Quality again: I am able to see how a problem has been handled over a long period of time in an easy glance instead of having to sift through page after page of notes for a particular item.
• Quality still: I am able to know that the average a1C for the practice or for a particular provider is X, and that the provider is or is not doing a good job controlling diabetes among their population.

Where are you with Meaningful Use? As an independent physician, have you benefited from the program, or found it overly burdensome?
I have attested three times, for Stage 1, and received three checks. The EHR reporting module makes this very easy, giving me essentially all the info I need to attest.

What other healthcare IT/clinical programs are you participating in at the moment?
I participate in the Physician Quality Reporting System, along with MU. I’ve received checks every year from them for doing this.

Has healthcare IT enabled you to remain independent?
It plays a large part. It takes a lot of admin burden from me and helps me be as efficient as possible, keeping me from having to join a hospital network.

What are your thoughts on the ONC’s 10-year vision statement for interoperabilty? Do any parts of its plan jump out at you as having significant impact on private practices?
My main thought about the plan is that this is something that should and COULD have been done already. I have preached to anyone who would listen that this is not a technology problem. It is a people problem. People in decision-making seats have just not felt it was worth their money or time to work with others to interoperate. It will be so easy to make happen when vendors and users decide that it is important enough to go ahead and do.

Sponsor Updates 

• Kareo and ChartLogic partner to deliver cloud solutions for surgical, orthopedic, and otolaryngology specialties.
• Truven Health Analytics launches its cost-sharing reduction analysis and reconciliation solution for health insurance exchanges. .
• ADP AdvancedMD supports the Greater Springfield Habitat for Humanity during a corporate team-building day. 
• E-MDs will offer Lightbeam’s population health management solution to its clients.

News 6/10/14

Top News

ONC publishes a 10-year vision statement on the future of interoperability. At 13 pages, it is “an invitation to health IT stakeholders … to join ONC in figuring out how we can collectively achieve interoperability across the health IT ecosystem.” Highlights include:

• Nine guiding principles that stress customization, educating and empowering the public, simplicity and modularity, and leveraging the market.
• Proposed development of an interoperability roadmap.
• Three-, six- and 10-year goals that widen the healthcare ecosystem with each successive year to incorporate stakeholders from outside of the traditional healthcare IT industry, as well as placing more responsibility on the individual patient to provide digital data to caregivers.
• Five building blocks upon which ONC will implement the aforementioned goals, focusing on core technical standards and functions, certification, privacy and security, HIE governance, and a supportive environment comprising all manner of stakeholders.

Several parts of the paper provide food for thought: How will Meaningful Use deadlines line up with these goals? The term “levers” is used throughout, prompting the question of whether ONC will continue to use carrots or sticks to promote interoperability. It does mention that “ONC will help define the role of health IT in new payment models that will remove the current disincentives to information exchange,” so perhaps carrots will be the method of choice. All in all, the paper makes plain that ONC will be around for some time to come, both as a certification body and driver of regulatory health IT change.

Perhaps in response to ONC’s renewed focus on interoperability, the CommonWell Health Alliance announces it will become officially interoperable this summer. The alliance includes such EHR vendors as Cerner, McKesson, Allscripts, athenahealth, and Greenway; as well as CVS Caremark and Medhost. It will be interesting to see if Carequality, a “competing” interoperability organization of healthcare stakeholders led by Epic, will soon follow suit.

The Senate confirms Sylvia Burwell as secretary of HHS. Her first, immediate item of business may be to respond to a trio of letters sent to her from industry organizations including the National Association of ACOs; Alliance for Connected Care; and American Telemedicine Association, HIMSS, and Telecommunications Industry Association. The letters ask HHS to pay for telemedicine services provided by Medicare ACOs. The NAA’s letter does an especially good job of pointing out that many physician-led and smaller ACOs can’t assume the financial risk of providing telemedicine consults for free.

Acquisitions, Funding, Business and Stock

Anthem Blue Cross and Healthcare Partners physician group (CA) announce their coordinated care efforts helped save $4.7 million in the first half of 2013 via reduced hospital admissions, emergency room visits and lab tests. The commercial ACO included close to 55,000 patients with chronic conditions in Southern California who were enrolled in PPO plans. Healthcare Partners established an ACO unit in 2012, and received additional fees from Anthem for its care coordination efforts.

A new study finds that athenahealth’s Epocrates is the top medical reference app on smart phones for the fifth consecutive year, and on tablet devices for the third consecutive year. Sixty-two percent of physicians who use Epocrates use their smartphones to access clinical content in between patient consults, while 39 percent access it during.

The EHR market continues to consolidate, as Medytox Solutions acquires ambulatory EHR vendor Globalone Information Technologies. Medytox’s current offerings include medical transcription, revenue cycle management, and other administrative and practice management software.

Announcements and Implementations

Non-profit primary medical and dental care provider ARcare (AR) receives the Stage 7 Ambulatory Award from HIMSS Analytics. It is the  first federally qualified health center in the U.S. to receive the distinction, and one of only two ambulatory practices not connected with a hospital.

Multispecialty group practice United Medical PC joins the Barnabas Health Medical Group (NJ), part of the largest not-for-profit integrated health care delivery system in the state. Barnabas Health seems to be on a bit of a buying spree, having acquired Jersey Medical Center earlier this month.

Wilmington Health (NC) transitions this month from its 10-year-old Allscripts system to the NextGen Healthcare EHR. The conversion team has been working with NextGen for 18 months to combine its practice management billing application and EHR into one platform.

People

Mr. H provides high-level background highlights of the newly reorganized ONC leadership team.

This article points out that incoming American Medical Association president Robert Wah, MD of CSC, has a healthcare IT background, having been an associate CIO and ONC’s deputy national coordinator. AMA 2015 president-elect Steven Stack, MD has similar roots as the long-standing chair of AMA’s healthcare IT group.

Innovation and Research

The California Association of Physician Groups releases the results of its annual Standards of Excellence survey, which evaluates CAPG members in California and 29 other states on six criteria, including health information technology. Cedars-Sinai Medical Group (NY) and Cedars-Sinai Health Associates (NY) were among the majority of physician organizations surveyed that achieved CAPG’s Elite honor. This year marks the first that CAPG issued the survey in an electronic format.

University of Washington researchers partner with Microsoft to demonstrate the ability to diagnose critical illnesses from a patient’s EHR using natural language processing and machine learning. The deCIPHER research team has so far studied the diagnosis of pneumonia in 100 ICU patients at Seattle’s Harborview Medical Center. The software achieved a correct diagnosis with correct time-of-onset for positive cases in 84 percent of the patients.

Other

The local paper spotlights Jeffrey Sketchler, MD and the three medical mission trips he has taken over the last two-and-a-half years with New Orleans Medical Mission Services. "In medical school, I had no idea that one day I would be doing something like this, but it has been very rewarding and a way to give back," says Sketchler, who, with a colleague, performed 39 knee replacements during his week-long trip in May to Nicaragua.

Lorre reports that she visited athenahealth’s Watertown headquarters in Boston last week, enjoying a social event, a campus tour, and a briefing from Jonathan Bush, who then autographed a copy of his new book for her. Perhaps next time she’ll get a sneak peek of the company’s Arsenal on the Charles location in development. Plans call for three pop-up shops that will vary from week to week. Wouldn’t it be fun if HIStalk merchandise were added to the retail lineup?

Sponsor Updates

• Zephyr-Tec signs a reseller agreement with nVoq to offer speech recognition to its current and future EMR clients for dictation and navigation.
• Optum executives will participate in a workshop with HealthEdge at AHIP’s Institute 2014 June 11-12.
• NextGen’s Sharon Tompkins discusses HQM and P4P reporting and why it matters.
• Allscripts offers presentation replays from its recent population health management analyst summit at the CCM in Pittsburgh, PA.
• E-MDs is named as Austin’s top biomedical R&D employer by the local business newspaper.

Practice Wise 6/9/14

There is no perfect software

Dear Doctor,

I really do understand your plight. It feels like the EHR is ruining your work life. You were not a day-to-day business software user until the advent of the EHR. It’s seemingly been dumped on you from on high, been made a big part of your day-to-day practice, and is probably something you didn’t want. The hardest part of this transition for you is to accept that nothing charts exactly how you think it should, because there is no perfect software. It takes a lot of effort on your part to make it work for you.

Hopefully, I can help you understand the complexities of EHR software in the same way my internist tries to explain to me the complexities of my middle-aged body and its various aches and pains.

True story: (Sorry for the TMI, but this is a concrete analogy.) I complained to my internist of pain in my left upper quadrant several years ago. As my diagnostician, she had many systems to consider as the source of the pain. There’s my musculoskeletal system, GI, cardiovascular, and so on. To rule out each of these systems as the cause of my pain, she took a history, palpated the area, and ran diagnostic tests that included blood work and imaging studies. When she still couldn’t figure out what was causing my pain, she referred me to one or more specialists. At that point, I started this process all over again, giving history of present illness, having full physical exams, and even more studies. Each doctor I saw had a different take on what was causing my pain and how to alleviate it. They depended on my willing and collaborative participation to figure out what was wrong with me. We travelled a road of trial and error together.

These things are not always immediately evident or clear cut. As the patient, I’ve not yelled at my doctors or the people doing the testing. I don’t threaten to sue my primary care doctor for not curing me on the first visit, or for referring me to other doctors that cost more money and still didn’t solve my problem. I understand that each provider is doing the best they can with the tools they have to find the correct answer and offer me a solution. Recently, the solution from my PCP was “Sometimes as you get older, things change and feel different and hurt, with no known etiology. You’ll to have to accept it, get used to it, and live with it.” I took it at face value and thanked her for her efforts.

Could you even imagine if you called your software company with a problem and they told you to live with it? Well, sometimes that is the answer. Usually, hopefully, they will try to develop a solution to your issue (if it is a real issue and not a user-interface issue). Sometimes the user is actually causing the problem – like your patient who is non-compliant and still wants to blame you for their woes.

When you call your EHR support company and state that something is not working, please realize there are underlying systems involved in what appears to you to be the single function causing you pain. First-level support has to triage the urgency of the issue, take a history of the problem, palpate the system, consult the literature, try a cure or two, and possibly escalate the case to a specialist. That support specialist may have to ask you further questions about your experience, continue to trouble shoot, and test solutions. If they can’t fix it, they send it up to development as a bug. The development team takes all bugs very seriously and works on them in a queue based on priority. Although the issue is your top priority, you may be the only one affected by this bug. They may have other bugs that affect a greater number of users, or reduces the functionality of the software in a more significant way. It’s the difference between an isolated stomach ache and a salmonella outbreak. They address the most critical issues first.

This is really no different than a doctor sending a patient out for referral and diagnostic studies when they don’t have the answer. Threatening to sue your vendor when something goes wrong is not an impetus for them to get it right. The impetus to get it right is already there. It’s their job and livelihood to keep customers working in their EHR. Cursing and name calling are also not exactly positive motivation! You wouldn’t consider having a patient treat you this way when you don’t provide an immediate cure.

At least once a week I hear someone say something like, “My spreadsheet program graphs better,” “My email does messaging better,” or “My document editor does that perfectly with spell and grammar check (amazing how many smart people absolutely rely on spellcheck!).” Each of those programs is basically a single-function product. The EHR has features embedded in a complex program that does a thousand times more than that single product. It’s just not that simple! I know that frustrates you, the end user, but it is what it is. Just like my flank pain is not that simple. It’s like me comparing my body to a perfectly fit 20 year-old. It’s not reasonable.

There is no perfect software, just like there is no perfect body. It’s all highly complex and variable. If you can realize that software development and support is a lot like practicing medicine, maybe you’ll be more comfortable with your new reality. Your vendors want your constructive feedback and input. You are the end user, and your day-to-day experience with the product is the most valuable diagnostic and improvement tool they have. Your patients are the best at healing when they collaborate with you in their care. Your software issues are best resolved when you collaborate with your vendors.

I have encountered quite a few physicians and allied health professionals who want me to help them find the perfect software because the first three they tried were all bad. My suggestion is always to look at the entire situation. If they can’t succeed with any product they try, maybe it’s time to take stock of what the common denominator is. Maybe they are unlucky and/or make poor purchasing decisions, and they’ve actually gotten three rotten apples. More likely, however, is that they don’t understand what their role is in making software successful in their practice, so they’re not giving the software a chance to actually work. If they’ve been through three products in four years, and the changes weren’t caused by product acquisitions, etc., then I tell them to take a long hard look at themselves. They need to honestly evaluate their expectations of the software against their willingness to make it work, and then be willing to do the work necessary to be successful. Before throwing the software out yet again, call on a consultant who is an expert in the field who can help determine if the user(s) or the software/vendor is the problem.

Again, assume I am talking about those good vendors who do care about their product and the EHR users who keep them in business, who make a strong effort to provide the best possible product and who respond to your issues. If my doctor blew me off and didn’t address my pain, I’d find another doctor. Thankfully, I have a good doctor, a collaborative relationship, and a pain in my side that we can’t figure out. It’s not her fault. I have faith that in time I’ll learn to live with it.

I hope that you too will learn to live with your software, and even embrace it!

Sincerely,

Your EMR Consultant

P.S. I’m open to a curbside consult!

Julie McGovern is CEO of Practice Wise, LLC.