Does putting an EMR into a primary care practice make life hell for a year?

We concur with Dr. Moore. The industry is not servicing the health care market with about 15% adoption of advanced clinical applications across all settings. “It’s the model”. The proprietary software business model competes on feature function and pretty screens while it makes its money on licensing and the complexity of implementation and training. The open source software business model is a much better match for health care.

Dr. Moore recently warned colleagues at the 2008 Scientific Assembly of the American Academy of Family Physicians to watch out for “monolithic and expensive” IT vendors, who have not given practitioners the right tools to better care for patients. He even likened the vendors to Pozni schemers. Unfortunately, Dr. Moore’s descriptions ring too true for practitioners. The healthcare industry has muddled through taxing, electronic health systems that really only work for IT vendors to make money. That is why we support Rep. Pete Stark’s recent proposal, which establishes federal standards and deadlines for a national, interoperable electronic health records (EHRs) network and promotes open source healthcare IT. We need systems that communicate with each other, not systems that communicate only with those that have the “right” expensive codes. We already have VistA, a proven and interoperable system. OpenVista, the commercialized version of VistA, is now in use in dozens of facilities. OpenVista participants share information and are empowered to drive the innovation themselves. There’s no game playing here. The community won’t allow it.

I’d have to agree it’s the sentiment of a majority of physicians out there. New England Journal of Medicine has a good survey report on EMR adoption in Ambulatory Care. While market penetration of enterprise EMR is above 50% across all hospital segments, NEJM shows that actual physician adoption is lingering at around 4%. It could be a matter of gradual technology diffusion, but I believe these numbers confirm the sentiment.

I think Moore is right on the money. Those “givens” that Peter Beck Kim mentions are not unavoidable. They are all tied to the reimbursement system. As long as the goal is to maximize billings, its all about what the payers want – not what the patients need. That’s why EMRs are long on coding support, but short on decision support.

Great advice, Matt. “Clearly useful and guaranteed to work” is something that physicians can judge for themselves and not require some global checklist.

Wow. There’s a lot here, and a lot worth commenting on. I think in the majority of cases, the unfortunate answer is YES… primary care physicians are in for a year of hell. What is really sad, however, is that in many cases it doesn’t have to be that way.

I have spent 17 years in the Healthcare IT business… selling, installing, training and supporting Practice Management and EHR Software. I recently got out of the “vendor game” and have been working as a hired gun of sorts for physician offices who are trying to make the leap to EHR. The real reason I decided to do this is quite simple. Consider the path most offices take to purchasing an EHR… it usually goes something like this:

1> Physician(s) determine for xyz reason, to begin considering EHR software.
2> They communicate to their practice admin that they want to do this, and to please set up some vendors to take a look at (maybe they have some ideas of their own as well)
3> Admin calls or contacts whatever vendors they know of (or find on the internet) that claim to do work with their specialty.
4> Vendors cycle thru with dog and pony shows and confusing contracts (that are rarely as simple as they are presented to be).
5> Physicians and Admin try to come to some sort of apples to apples comparison between quotes, (since every vendor claims theirs is more expensive because there are more features included, etc).
6> A decision is made with the best info available, and contracts are signed
7> Vendor schedules for implementation, training, etc with practice manager (or rarely, some other designated employee)
8> Training begins (and so do the headaches)
9> It becomes clear that something needed wasn’t in the contract, and that has to get added (usually an added cost)
10> Physicians were trained, but there are some things about the “templates” that will simply not work the way they need them to… so they will need to be altered (which you find out is either impossible… or something you have to pay for… or do yourself…)
11> Add many more lines of things like conversion problems, code-passing between EHR and PM, e-Rx not sending properly, Lab interfaces that “should” work, but never seem to get set up, etc, etc, etc.

Now… while it is probably sounding more and more like I am not an EHR advocate, nothing could be further from the truth. I believe fully in what a solid EHR software can do for a practice.

In my estimation, you simply cannot load the burden of working all of this “stuff” out onto the plate of a practice manager, or any other employee for that matter. If you do… you will LIKELY pay the price by living in Hell for a year or more.

If it hasn’t already become apparent, the reason for this is pretty simple… you and your staff will fight this fight (while trying to do your real job) until the pain of using the system has subsided to a degree that you can live with it… and then you go back to trying to run a practice with whatever system benefits you have managed to accomplish within that timeframe.

My job is to try to prevent this “plateau” by being a point person for the project until everyone is comfortable and all phases of the project are complete. I strongly feel that this is the missing ingredient for many practices trying to do these projects… and I think it gives EHR systems a bad rap overall.

I would be happy to do my best to lay out some common items to plan for, but therein lies part of the problem. This kind of project is not at all like installing a new billing system (even though many vendors seem to treat it that way in many respects), this is something that will personally touch virtually everyone in the office… most importantly the folks at the heart of the production engine, the doctors and clinicians.

Perhaps a more productive article would be setting proper expectations for a project like this, coupled with some common pitfalls and warning signs?

Let me know… I’m happy to help where I can! You can also check out my website for more ideas at http://www.ehr-consult.com. I did the website myself, and I’m no programmer… so be kind

Maury Johnston – President
Paradigm Consulting Group
Myrtle Beach, SC