News from Mendelsohn Consulting, Inc.

Healthcare IT is a hot button topic these days among physicians. There is an irony to this that is lost least on physicians themselves, who are well aware of their traditional reputation as technophobic. This stereotype has long been inaccurate (since when is an MRI low-tech?) but has been given a fresh airing over the past year by the well-publicized reluctance of physicians to embrace the use of Electronic Health Records (EHRs).

Far fewer than one in ten physicians (1) or hospitals (2) use a fully-functioning EHR despite increasingly well-documented evidence that properly implemented systems can improve patient care and lower costs. This on top of pressure from a looming Federal requirement to begin using EHRs, backed by a reimbursement carrot of nearly $20 billion of funding from the American Recovery and Reinvestment Act of 2009 and a nearly unquestioned popular belief that more medical technology is better.

What gives? Physicians have been avid users of new technology in hospitals for decades, as any pause to consider the progress of the battle against myriad diseases will attest. Consistent with this past, many individual physicians say they are willing to use new technology, provided it is simple to use, isn't too expensive and won't become obsolete too quickly. For example, the percentage of physicians using smartphones such as the iPhone and Blackberry in their clinical work is estimated as high as two-thirds (3), far greater than the 15% or so smartphone use in the general population. The favorite physician smartphone by far is the iPhone, preferred for its ease of use and the size and quality of its screen.

So, what's the problem with EHRs, a technology that physicians appear to love to hate? It is that so many physicians find them the exact opposite of what they want: complex and time-wasting, expensive and of uncertain longevity in the fast-changing world of software technology. Now that physicians actually will be required to use them, the chorus of complaints has risen to a high enough pitch that politicians have begun smelling political opportunity, notably Chuck Grassley (R-Iowa) a powerful senior Senator. He has written two letters to major EHR vendors and hospitals over the past several months, the last pointedly demanding answers about how overly complex, badly designed EHRs might actually be harming patient safety (4). Some observers see this type of scrutiny as the leading edge of EHR regulation.

Away from the EHR ferment, hundreds of thousands of physicians go about their jobs every day using innovative, web-based technology that they swear by. What do they like? Below is a short list of applications many physicians wouldn't go without. Not surprisingly, all of them are simple to use, save time over the traditional way of doing things and are inexpensive. All are available not only on the web but also on smartphones. The services typically charge a monthly or annual subscription fee. In practice, many individual physicians never see a bill because the relatively small cost is borne by their practice, hospital or residency training program.

The best known of these new services is Epocrates, a drug reference that physicians young and old swear by because it is simple to use, answers basic but critical questions about medications and saves time over the thick drug reference book they traditionally stuffed into their lab coat pockets. Physicians say Epocrates's greatest strengths are the pill pictures it provides and the speed and accuracy of its information updates on new and existing medications. The service comes in several flavors ranging from free to $299 per year.

Another application many physicians wouldn't do without is UptoDate, a very simple, web- and mobile-based clinical information resource that does one thing: gives answers to the questions physicians have daily about caring for their patients. The service saves physicians time because it replaces the traditional phone call (or perhaps email) to colleagues, a process that in many cases is now considered too slow and cumbersome. UptoDate's answers are considered credible because they come from a large editorial board of fellow physicians as well as peer-reviewed medical journals. The service charges an annual subscription ranging from about $200 to $1,500 depending on the number of users.

Then there is Medscape, a WebMD property that is a physician favorite. Online since the mid-1990s, Medscape is used by many physicians as their go-to site for specialty-specific clinical information and news. Its voluminous content helps physicians stay on top of important developments in their specialties, saving them from the traditional medical journal reading for which they no longer have time. Medscape's wide-ranging offerings compete with many of the more narrowly-focused services such as Epocrates and UptoDate and, even if many physicians feel they outclass it, MedScape has one advantage - it's free.