For the past two years, the real fun at the TEPR show has been watching a platoon of software vendors sweat through public time trials of their electronic medical records systems.
TEPR stands for Toward an Electronic Patient Record, the direction in which the show's sponsor, the not-for-profit Medical Records Institute of Newton, Mass., has been trying to lead physicians and hospitals for 17 years. From this year's show in Boston came mixed signals about industry progress toward EMR adoption, but the software, at least, performed well on stage before about 1,000 potential customers-unlike last year's trials, where several systems crashed.
Still, vendors under glaring stage lights nervously clicked their mice, clacked their keyboards and stabbed their styli at their computer screens as every digitized move was projected onto a giant screen.
Each had 10 minutes to document the office visit of a mock patient. A few ran out of time. Some flubbed. One recorded the female patient as a 2 million-year-old male. But most made the deadline, some with time to spare.
One was Robert Oliverio, M.D., who practices internal medicine with The Medical Group of Beverly, Mass. He used a tablet computer and an EMR from PennChart of Glastonbury, Conn., the only wireless application of the 12 EMRs showcased.
"Every year it gets better," said Ross Martin, M.D., senior manager of business technology for Pfizer Pharmaceuticals Group of New York City. Pfizer Health Solutions, an arm of the drugmaker, is marketing the PennChart system.
"And while there were a lot of approaches to data entry that were different, the gaps between them were closer and the bar is getting higher."
Several EMR vendors said sales were up, but none suggested a rush to buy EMRs was imminent. EMR adoption rates have run between 5% and 15% for years, said TEPR panelist Charlie Koo, CEO of Mountain View, Calif.-based vendor iMedica.
Since vendors are reporting sales, "that means there are probably about the same number of deinstallations as installations," he said. "That's the scary part."
In the annual survey of TEPR show attendees, providers said lack of funding was the key barrier to implementing an EMR system. A question that broke down the electronic health record into 18 functions asked what functions attendees expect to roll out in the next two years. Results showed little change over last year.
Those considering the use of application service providers (ASPs) within the next two years showed across-the-board decline in expectations since last year, the survey summary said.
Privacy was on the minds of TEPR speakers and attendees alike. More than half (57%) of those surveyed said their major concern regarding privacy and security of patient records was unauthorized users accessing records, while 39% said it was inappropriate access by authorized users outside the organization.
Keynote speaker William Winkenwerder, a consultant and a former president of Blue Cross Blue Shield of Massachusetts, warned of a potential meltdown for electronic health technology.
"I think privacy and security are the Chernobyl that is waiting to happen for the healthcare industry," Winkenwerder said. From tort laws to the guarantee in the Constitution that persons should be secure in their personal papers, "the right to privacy is . . . embedded in our culture. Privacy is going to be our greatest hurdle, and we must protect it in order to succeed."
Yet many healthcare software and e-health services vendors sell patient data, particularly ASPs, says TEPR panel leader Mindi McKenna, CEO of eHealthCoach.com, a Kansas City, Kan., consulting firm.
For many of the ASP models, "a lot of the ways they make money is they scrape (and sell) that data," McKenna says. Physicians who collect the data on their systems unwittingly pump it out to an ASP without profiting from its resale because "a lot of times, they don't know to ask."
McKenna says she knows of physician groups who share in this income stream, but she declined to name them.
"It's legal. The point is, does it fit within their paradigm of medicine?" she says.