Dollars and Nonsense

October 26, 2011  |  Category: All Things EHR

If EHRs are being designed with the presumption (or requirement) that physicians will spend several weeks learning how to use them, there’s a fundamental flaw in EHR design. Because the very notion that a physician will voluntarily invest weeks in training specifically to learn how to use a computer system is patently absurd.

Yet that seems to be what’s happening, based on a new survey that found “at least three to five days of EHR training was necessary to achieve the highest level of overall [physician] satisfaction” and “at least one week [of training] was correlated with improvement in the reported usability of advanced EHR features.” ModernHealthcare.com reported “the survey also found that ‘ease of use’ ratings continued to increase with two or more weeks of training on basic EHR functions such as maintaining drug allergy lists and checking for harmful drug interactions when prescribing new medications.”

Let’s do a little back-of-the-envelope math:

  • Say a primary care physician (PCP) works 240 days per year to generate $400,000 in revenue, and has a (industry standard) 55% overhead ($220,000), resulting in a take-home pay of $180,000.
  • This same physician gives up 10 working days in order to get the necessary EHR training to become a “meaningful user” of his or her new system. The doctor gives up $16,667 in revenue, reducing their gross to $383,333 for the year; but overhead is unchanged at $220,000 — so their net is now down to $163,333.
  • Now subtract the cost of the EHR software, maintenance and services (which is not part of the PCP’s 55% overhead). Whatever this is comes directly out of his pay, but you can add back in a one-time payment of $44,000 (which may be approximately the cost of software, maintenance and services) – so call it a wash.
  • Now, if you want to really pile on, subtract 30% from the $400,000 — which is the government proposal for cuts to physician payments in 2012 — and his/her take-home drops to $43,333.

Even if this doctor survives the year, their future isn’t exactly rosy — because any software that takes so long to learn to use will result in a long-term productivity hit that won’t even be partially offset by government incentive dollars.

So is this really what the healthcare IT industry is delivering to physicians? EHR systems that require weeks of training? That’s nonsense – and very expensive nonsense, to boot. We can (and must) do better; NIST’s draft EHR usability report may offer a good starting point. Otherwise, we’ll automate PCPs right out of business.