As Healthcare Dive recently reported, a new study has concluded that at least in the outpatient arena, EMRs can raise revenue while lowering patient volume. The study, which appears to been fairly comprehensive, compared patient volume in reimbursement at 30 ambulatory practices for two years after their EMRs were implemented. The researchers noted that they saw no signs of upcoding or growth in reimbursement rates to account for the growth in revenue per patient.
For EMR fans, this sounds terrific, and suggests that further investment in such technology is likely to yield a return. But alas, nothing is that simple when it comes to the EMR world.
In fact, other studies of late have drawn completely different conclusions in similar environments. For example, new research appearing in JAMA Internal Medicine reports that doctors say they waste an average of up to four hours per week when using EMRs. The study, which posed 19 questions to 411 internal medicine attending physicians and trainees who worked in ambulatory practice and used an EMR, found that almost 90% of respondents said at least one data management function was slower, and 64% of respondents said the time taking notes increased. This certainly doesn’t sound like a situation in which the EMR is boosting revenues on improving efficiency.
Why can’t EMR research get the bottom of this?
You’d figure, with the government spending some $20 billion in incentive payments to encourage EMR use, that the industry would have the details as to just what benefits they offer, how to use them in the most effective way, how to leverage them to improve provider workflow and revenue and how to configure them to make them easy to use. And you’d assume that there would be some research consensus as to how to get these things done.
The sad truth is, however, that nobody seems to have the slightest idea how to standardize these approaches, and research seems to produce conflicting results that only makes things worse. The reasons are varied, but major factors include the following:
Standardizing EMRs is near-impossible
In theory, EMRs have the same job to do everywhere they go. In reality, though, even vendors certified for Meaningful Use are in no way in lockstep. And when EMRs are implemented, they must be adjusted to the unique workflow patterns of individual hospitals and medical practices. One has to wonder what the medical practices were doing in the Drexel University study that found growth in revenue per patient. In the context of the industry as a whole, it seems likely that this result is an anomaly at best.
There’s too many EMRs out there
When the government is handing out money hand over fist to providers who buy EMRs, there’s going to be a ton of vendors out there eager to meet your needs. The problem with that, however, is it discourages the industry from coming together in setting standards that simplify the way their core products work. I’ve stopped counting at this point, but there’s got to be hundreds of EMR vendors on the market, and they simply don’t cooperate much. And with providers using so many different types of EMRs, researchers are likely to come up with different conclusions as to their effectiveness, logically enough.
Different EMRs aren’t compatible
Part of what sucks the value out of EMRs is the reality that providers can’t share data with one another. Free, compatible data flow from doctors to hospitals to other health facilities is still at a primitive stage. That’s the case despite demands from policymakers that EMRs become “interoperable,” a nice way of asking that vendors drop the walls forcing providers to use their product and their product only. Researchers are forced to homogenize data coming from multiple vendors, which is likely to result in widely varied conclusions as to where it EMRs ought to head.
Frustrated by all of these complexities, doctors and even hospitals with gigantic investments are increasingly considering another a new EMR, though unfortunately, they may find that the workflow problems, vendor support, lack of data flow and other crippling problems just pop back up again with their new vendor. While the reality is that providers probably need to invest (and reinvest) in EMRs to survive these days, we’re far from the day where it’s an easy or well-understood process.
