Third, for the first time in our five years of investigating healthcare technology, reported EMR use actually declined. In 2007, 39 percent of practices reported having an implemented EMR. This year, only 35 percent did. Our best explanation: Physicians are abandoning systems they implemented. Why on earth would they do that? Because they never really made proper use of the system, or the system itself failed to deliver on hoped-for cost savings.

Part of the confusion is that we’re now in the “upgrade” stage of EMR adoption. Follow-up interviews revealed that physicians who bought low-cost and low-complexity EMRs are now moving on up to more costly and more complex systems. It’s round two.

Case in point: Susan Andrews originally used the very first version of e-MDs simply to generate charts for her family practice. When the Murfreesboro, Tenn., clinic went independent, leaving the nest of a hospital-owned setup, it decided to move on to “something a little more robust with billing and a scheduler plus the EMR,” Andrews says. Now she uses Practice Partner to handle everything from charting to e-prescribing. And she got patients on the bandwagon, too. Medfusion, a Web portal that runs through Practice Partner, lets Andrews do online housecalls, and patients can type their own medical histories into their chart from home or in the office.

Krichmar had a similar experience, realizing more advantages from a system that goes beyond charting. His practice, South Florida Cardiology Associates, acquired its first EMR in 1997. “The first one was a way to cut down on transcription costs, but I never fully used it, even though it was in place eight or nine years. I was only using 25 percent of the system. I was just using it for better documentation. … If we were audited, it was there. But the only money it was saving was transcription fees; it wasn’t really making us efficient.” Now with gMed, Krichmar is much more confident that he’ll see more savings because this new system requires the practice to change how it works.

Voice recognition praised

Another handy piece of healthcare technology is voice recognition software. That’s software that transforms your voice into typed documentation. Only 18 percent of the physicians responding to our survey currently use voice recognition, but those who do use it, like it.

Given the success rate, it’s surprising that voice recognition usage isn’t growing faster. In 2006, about one in five practices used voice recognition. Last year, 19 percent of our respondents were using it. Forty-three percent said it only took them a day to get their software “trained” to recognize their voice, and 58 percent have entirely stopped using a transcription service.

Management systems need help

For all the chatter about EMRs and other documentation-related technologies, it’s practice management where the biggest growth seems ready to hit. While 37 percent of respondents installed new management software within the past two to four years, more than a third are still using systems that are five to 10 years old — a veritable geologic age for technology. Another 13 percent don’t use any management software at all.

And here’s the kicker: A full 60 percent of respondents don’t really like their practice management system. Most complain that their software doesn’t make it easy to generate reports that can help practices identify where things are going wrong. Others want a more intuitive interface or less expensive upgrades.

Other technologies used less

Given the complexity of coding, it’s interesting that only about half of all practices use technology to help select codes. Of those that do, 29 percent had revenue growth beyond 10 percent as a result. Another 20 percent also realized more cash, though less than 10 percent more.

Physician-patient e-mailing remains fairly limited as well: Thirty-four percent of practices do it, and the overwhelming majority don’t charge for it.

And while 64 percent of practices do have a Web site, only 21 percent of them use their sites to interact with patients in any way, such as scheduling an appointment or requesting a prescription refill.

Toward the future?

Reluctance in adopting technology might be expected, given physicians’ general skepticism about such things. Most have a sense that the promise is a lot bolder than reality. Here are some typical, ahem, suggestions that readers provided to vendors:

Do not oversell your product. Be open and honest with the advantages and limitations of the specific product you are offering.

Quit lying to us about how great your products are.

Marketing pitches do not correlate to actual technology performance.

Ouch.