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Is Your Medical Practice Being Forced to Use the Hospital's EHR?


After a foot injury landed me in an orthopedists’ office last year, I received a “robocall” call from the practice informing me of its new EHR. The new system is going to be just great, said the recorded voice, but would I mind being patient while they made the transition?

At my next visit to the hospital-owned practice, the doctor struggled to retrieve my X-rays while muttering about the frustration of navigating the system that “they’re making us use.”

Just another day at a hospital-owned practice?

I’m wondering whether the medical profession’s continuing movement away from its independent roots and toward hospital employment is sustainable-and if so, how physicians will feel about their careers and their lives as worker bees-and that’s why that office visit has stuck in my mind even though my injury has long since healed.

EHRs and other health IT tools are likely sources of particular frustration in this new world, for two reasons: First, the physicians will have had little if any hand in selecting the technologies they’ll have to use, and they’ll be expected to use those tools in particular ways, regardless of their own preferences. Hospital-owned are six times more likely to be using the hospital’s EHR than one they selected, according to our data.

Second, those hospital-owned EHRs are designed with hospitals’ needs in mind, not practices’. No matter. Most of those working in hospital-owned outpatient offices will be forced to adapt to EHRs that are designed for hospitals. Like a finicky child who’s told “You’ll eat what the rest of us eat,” employed office-based docs will just have to make do with the hospital’s system, even though it was never designed to be used in a clinic.

“It’s my observation that there’s a whole bunch of enterprise-class technology that’s being shoved down the throats of small practices, really because of the nature of how the industry is structured,” Rob Pickell, chief marketing officer at Kareo, a maker of EHRs aimed at small practices, told me. “It’s like going into your local Subway shop, and seeing them running Oracle. That’s what it’s like in a lot small practices today. ... It just doesn’t make a lot of sense.”

Kareo, which drafted a white paper on the attention small practices are getting (or aren;t getting) from the EHR vendor community, may be on to something, according to Physicians Practice's data. The full results of our 2013 Physicians Practice Technology Survey, sponsored by ZirMed, will be released next month (look for it here, in our June print issue, and in our next tablet edition, and meanwhile check out last year's results), but consider the data points below:

Practices that:
Have their own EHR
Use a hospital's EHR
Use an EHR that's mobile-friendly
Are happy with their EHR vendor

Have a look at that “happy with the vendor” number. If you work for a hospital, you probably don’t like your EHR. If you’re independent, you probably do. Why? Because independent docs selected their own vendor and the employed docs were told what they’d be using. That distinction shows up in the percentage of docs using mobile-optimized systems. Mobility is a priority for docs who don’t want to be chained to the office. But your hospital CIO? How much of a priority is it for him to make sure that you can check patient records during Mad Men commercials?

Hospitals purchasing physician practices are hoping to align the docs within them around their own goals. That’s a tall order, and IT integration is likely to be a crucial battle ground.

Hospital-employed docs, are you being required to use the hospital’s EHR or you able to use your own? And what’s your take on the quality of the systems you’re using?

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