At a time when many doctors are complaining loudly about the requirement to use EHR software, which they find hurts their productivity more than it helps, Howard said Practice Fusion has a strong incentive to make its software usable because the only way his company makes money is if the software is actively used.
The usability and productivity concerns doctors are voicing about the time and effort required for data entry are very real, Howard acknowledged. "If it slows them down enough that a doctor can see one less patient a day, that would wash out all the incentive dollars," he said.
The challenge is to allow doctors to collect all the data required for billing, analytics, and health information exchange with other systems, but do it in a way that competes with the simplicity of paper, Howard said. "Paper is hyperflexible, if you think about it. For just dumping data, it's fantastic."
Electronic systems, in contrast, require that data be neatly categorized, and navigating through EHR screens is going to become even more challenging as the US adopts ICD-10, increasing the number of diagnosis codes from 13,000 to about 68,000. However, Howard said there ought to be a way to leverage the volume of data that flows through the Practice Fusion system to do some predictive analysis and suggest the appropriate codes to be entered for any patient visit based on that patient's past history and the codes other doctors have chosen in similar situations. "That's one of the massive unrealized potentials of the cloud," Howard said. "We believe our community has more knowledge between them than any single source of medical knowledge out there."
Dr. Allan Treadwell, a San Francisco internist and early Practice Fusion customer, said he accepts that logging data in an online system is going to take a little longer, but he has also seen the payoffs. "Frankly, it's changed the way I practice medicine in a lot of ways," he said. For example, when he wrote prescriptions on paper, he was dependent on the pharmacist to check it against a formulary for possible drug interactions. With an online system, he gets an immediate prompt letting him know when he needs to prescribe something different.
"It does slow you down to a certain degree, but again with e-prescribing I'm looking at drug interactions, which is something I wouldn't even have seen before. So we're catching these potential medical errors at an earlier stage," Treadwell said.
"We think we've cracked the code on engaging the doctors," Howard said, although the service probably still needs to do a better job addressing some specialties. "The biggest challenge we have coming up right now is truly patient engagement." In particular, he's in search of the gamified experience that will get people to engage regularly with their health record, using it to proactively manage their own health.
"Engagement is tremendous for patients who are sick, but it's very fear based," he added. The ideal would be to facilitate ongoing engagement between consumers and healthcare professionals to catch problems earlier, with more questions asked and answered outside of the context of a traditional visit. "Concierge medicine for the masses is the tagline I'd put on it," he said.
A worthy goal.
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