On my recent travels, I had a glass of wine with a 50-ish family physician from the Midwest. We talked about the trends in the health care field in general and about primary care in particular. Of course, I mentioned all the opportunities in primary care management of medical homes, the use of electronic health record (EHR) data to coordinate consumer care, and the evolution of care delivery to an on-demand model using technology.
Much to my surprise, he said, “Our practice and our 12 physicians do not have an electronic medical record – and we don’t plan to have one. Our insurance company keeps talking to us about the dangers of answering email messages, so we’re not planning to do that either.” To me, this conversation illustrated the system disconnect in health care policy versus health care practice.
So where are we? If we’re talking about hospitals, nearly all (96%) used a certified EHR in 2015, marking an increase or 71.9% since 2011 – and primary care physicians showed an even higher adoption rate at 79% (see 96% Of Acute Care Hospitals Have Adopted Certified Electronic Health Records). But recent headlines like these – MD Anderson Points To Epic Implementation For 77% Drop In Adjusted Income, Southcoast Cuts 95 More Jobs After $100M Epic EHR Installation, Survey: EHR Switches Resulted In Higher Than Expected Costs, Layoffs – make managers nervous.
If we are talking about telehealth adoption, 67% of health care professionals either use it or plan to use it in the next few years (see The Telehealth Market – Now, Soon & Future). And if we are talking about the “basic” technologies used for front office business, an OPEN MINDS survey of nearly 200 provider organization executives in 2016 found that 22% communicate with consumers via email; 78% have a public website; and 44% use practice management software (see From iPods To Cloud Computing – 2001 To Now).
But there are problems, as any quick scan of the trade headlines can show (see Frustrations Linger Around Electronic Health Records And User-Centered Design and ONC Report Confirms Struggles On EHR Interoperability). Challenges for provider organizations are no surprise. And I remember the first OPEN MINDS Institute for Behavioral Health Informatics back in 2005 – then senior management scientist at The Rand Corporation Richard Hillestad, Ph.D. said in his keynote “Technology-Driven Transformation of Health Care: A Strategic Perspective” that EHRs would likely save money for payers and health plans, but not necessarily for provider organizations (see EHR Interest Reaches a Political & Technological Peak: CMS Offers Access).
The challenges to adoption are many. In one example, an online therapy site guarantees anonymity to consumers to the point that professionals are unable to report (as required by law) dangerous persons or situations (see Online therapy sites grapple with legal, ethical dilemmas). In another, reimbursement still remains “the primary hurdle” to greater telehealth adoption (see Reimbursement Persists As Obstacle To Telehealth Adoption) and Medicare coverage remains limited (see JAMA: Telemedicine Visits Remain Low for Rural Medicare Patients). And despite the ubiquity of communication technology in the world today, connectivity and technology reliability still remain an issue (see Challenges And Burdens To Mainstream Telemedicine).
Does that mean telehealth has a limited future? I really don’t think that’s the case at all. In 2016, according to the latest edition of State Telehealth Laws and Medicaid Program Policies A Comprehensive Scan of the 50 States and District of Columbia:
- Forty-eight states (and Washington D.C.) provide reimbursement for some form of live video in Medicaid fee-for-service (FFS), up one state from March 2016 (Massachusetts and Rhode Island are the exceptions).
- Twelve state Medicaid programs reimburse for store-and-forward services, up three states from March 2016.
- Nineteen state Medicaid programs provide reimbursement for remote patient monitoring, up three states from March 2016.
- Seven state Medicaid programs (Alaska, Hawaii, Illinois, Minnesota, Mississippi, Missouri and Washington) reimburse for all three.
But, at the present time, no two states define or regulate telehealth in the same way (see The Uneven Adoption Of Telehealth – The Idaho Example and Tracking The Shifting Map Of Medicaid & Medicare Reimbursement For Telehealth).
So what to tell my physician friend? My advice was that you can escape the EHR if you’re in a concierge or cash practice. But to have the concierge or cash practice, those consumers expect “tech-enabled” as part of your expertise. That is the challenge.
It is a classic example of policy and practice and market colliding. Every organization providing clinical services needs both a new business model for the emerging market opportunities and a “change management” plan for their clinical talent. For more on balancing the uneven evolution of the health and human service system, check out:
- Health Tech That Will Change Our Lives
- 10 Management Insights Your Competitors Don’t Want You To Know
- Uncertainty Ahead Making Your Team Stressed? How To Keep On Track In A Time Of Change
- Is Your Organization Nimble? Take Our Quiz
- I Know We Can’t Keep Doing What We’re Doing
- The Telehealth Market – Now, Soon & Future
- The Telehealth Market – The Future Has Arrived
- Primary Care Goes Virtual & On-Demand
- The Latest Telehealth Example: Pay-For-Value
- The Uphill Climb To Virtual Care
For more from executives who are making it work, join me on February 16 at The 2017 OPEN MINDS Performance Management Institute for the session “Alignment Of Care Delivery & Value Based Programs: Integrated Care Models To Produce Improved Outcomes Within Complex Populations,” featuring Orville Mercer, MSW, Vice President, Behavioral Health, Chestnut Health Systems; Bill Guptail, Senior Vice President, Payor Relations, Genoa a QOL healthcare company; Mona Darwich, Program Director, LaFrontera Southwest; and Shahzad Rashid, DO, Psychiatrist, Genoa Telepsychiatry.