As the previous commenter Dr. Duncan notes, the survey, and your spin on it, is a bit suspect. First question to ask when reading the results on any survey or poll is, who paid for it? In this case, an EHR vendor. Hmm.

Second, look at the questions asked, and the numbers themselves. Once that's done, you can begin interpretation. But your article is in such a hurry to interpret, I'm suspicious. To your credit (and I mean this sincerely) you gave enough information to read between the lines.

I agree with Dr. Duncan (previous commenter) that 100 physicians is hardly a sufficient sample size to make a grand declaration concerning the "2011 State of Small Practice". A "nationwide" survey? At best we have 2 doctors from each state, but I doubt the distribution is that balanced. Are these all (perhaps) Practice Fusion customers? If so, the survey is actually pretty damning.

Next, let's look at the numbers and the way they are presented. According to the numbers, you could just as easily have said,"a full 72% of physicians reported that their practice was doing no better or actually worse than last year." That too would have been a spin, but not much.

While 69% said they are extremely satisfied with their career, and 59% indicated improved technology is a factor in making things easier, this doesn't translate into concluding that physicians' career satisfaction has anything to do with the joy of data entry or that EMR technology is the technology that is making their job easier (might they be referring to email, iPhones and the web, perhaps?).

This is confirmed by the fact that, as you indicate, a paltry 11% "cited improvements in overall efficiency and HEALTHCARE (my emphasis) technology as impacting their practice positively, and 7 percent cited having an electronic health record as a positive trend." That means 89% did NOT applaud improvements specifically in healthcare technology, and 93% failed to give a hurrah for the adoption of EHR technology. Wow. When a political candidate has a 7% approval rating, they usually drop out of the race. Yet that's not the feeling portrayed.

Finally, despite the EHR vendor's attempt to spin EHR adoption as a positive factor, it is not even mentioned in the top three "positive trends impacting their practice".

Again, as Dr. Duncan mentions, the great benefactors of EHR technology under the present paradigm are large institutions in government, insurance and pharmaceutical research, all of whom salivate over huge data warehouses with patient data collected meticulously by someone else at someone else's expense. And, as with any gold rush, it is usually the outfitters who strike it rich, not the ones who actually do the prospecting.

My complaint is not with technology, or with digitizing healthcare information. Done right, this will doubtless bring all the benefits that are commonly touted. But economics, implementation and regulation can totally screw up a very good thing, and that's what I believe is going on now. We claim to let "the market" take care of things, but in this case we have let "the market" be driven by powerful players who are not primarily the users and supposed benefactors of healthcare technology, that is, physicians and patients. Instead, convinced that EHR adoption is a good thing (and again, I believe it is), we don't listen to anyone (including say, 93% of physicians polled) who says the way it is being done isn't working. When you don't listen to your market, how can you claim your efforts are driven by the "free market"?

Patrick J. Casey, Consultant