Guest Article: Why Doctors Hate Electronic Medical Records

July 26, 2009


Most of us in the healthcare IT believe the ARRA (stimulus) bill is a Good Thing for the industry in general. Many existing companies will be able to sell more products and many new companies will be formed to create electronic medical records solutions. I was talking to Dr. Bill Cast last week about EMRs and what he and other physicians thought about them in general and I got some great feedback. Dr. Cast is a practicing Otolaryngologist, and is a past member of the AAO Board of Directors and AMA Delegate from Otolaryngology. He has been a lobbyist for the Indiana Malpractice Law and founding Chairman of Dupont Hospital in Fort Wayne, Indiana, a managing partner of his medical practice, and President of several multispecialty ambulatory surgical centers. He was editor of Medical Business Review, an economics newsletter for physicians. He is currently CEO of www.nomoreclipboard.com, a personal health records company. I invited him to share his thoughts about why physicians aren’t in love with EMRs which should form some good input for companies looking for ways of improving their own solutions. Here’s what he had to say.

You may ask what qualifies me to speak. First, I am a physician in a six doctor practice who for eight years has been digital, using a fully-featured EMR. Our old record room is now an employee lounge serving Peet’s Coffee. I live in an Indiana city in which 65% of physicians use some form of EMR in their offices and in which a regional health information exchange serves 95% of all providers. Our two hospital systems have EHRs. I’ve practiced in four states, served in the U.S. Army as a surgeon and have worked intermittently in a VA Hospital over a 6 year period. Lastly, I’m CEO of a personal health records company, a spin-off of an EMR company. And so, I’ve seen lots of software installations and talked to lots of unhappy doctors.

How do we know doctors hate EMRs? Look at anemic adoption rates. Big clinics and large physicians’ groups lead the way in buying them, but the most optimistic statistics say that fewer than 50% of even large groups have EMRs. Overall, perhaps 20% of physicians have EMR, but for small groups the best guess is 5%. And, when such features as e-prescribing, e-visit, and PHR integration are considered, it is likely than less than half of physicians use their EMR for little more than their own templates and a few favorite features. The majority of physicians have voted with their feet.

In the business community it is common to hear doctors referred to as computer-phobic and “in denial” about the benefits of computing. That is wonderfully ironic when heard alongside chronic complaints that doctors are overly eager to use expensive technology: lasers, cryro-probes, fiber optics, MRI and PET scanners, stents, and implants. The fact is that doctors love high-tech. They have reason to hate EMRs but not computers and iPhones. This was confirmed at a HealthVault meeting in Redmond when a physician panel member, representing a leading medical association, was asked: “Why are physicians so recalcitrant to use EMR?” He responded: “They are not recalcitrant; they are in open rebellion! Why? Because the software you give them is garbage.” (He actually used a mild expletive.) “It slows them down!” Thus, the problem is better defined: it is not so much that the software is too expensive, but that doctors can’t afford it.

Most physicians receive their first scars at the hands of hospital software. The truly unlucky have experienced a software installation with conversion from paper to EHR. The experience I will share is instructive and metaphoric. I’ll mention no brand names, because the story could be as true for any company. The disaster began on a Monday morning. Following that regrettable morning, I witnessed over two months of computer downtime at a six-hundred bed, general hospital, during which time hired messengers carried paper reports from floor to floor, from lab to ICU. The new system choked when millions of bytes of information were ported from the database to the new system the previous Sunday. Several ICU nurses quit after weeks of frustration and found new employment. And when the crash was fixed, the new product was a negligible improvement for phsicians. For off-site use, a Citrix interface made access to records agonizingly slow. Inside the hospital, computer locations, while no longer in dark hallways, became inconveniently distant from patients’ rooms, dictated by HIPAA privacy requirements. Paper charts remained near patient beds, awaiting eventual digital scanning, but lab and imaging results were often not on the chart but on a computer down the hall. The dollar cost was millions.

It should be a surprise to lay persons that physician participation in selection of hospital equipment and software is too often minimal. While much of the blame may lay with physicians themselves, doctors’ frame of mind is usually that “we were not consulted.” Actually, a few probably were consulted, but hospital-staff dynamics being what they are, tends to involve doctors who are the more technically aware, enthusiastic and amenable to becoming digital. To that disparity in physician cyber-skills, add the fact that software does not burden physicians equally. Even badly designed hospital software is OK for some practices and some specialties. But, if you are a renalogist or pulmonologist making rounds on numbers of very sick patients, the math is simple. Many ICU patients are on a dozen medications. With order-entry requiring serial drop-down menus, each 5 second addition of point and click may add 10 seconds to the entry of each medicine and treatment. An extra 2 minutes per patient costs an unproductive hour for each 30 patients. If patients need few medicines, enjoy short stays with few I.V. fluid orders and no changes in ventilator protocol, a physician may not object to the restrictions of a rigid algorithm. But for rounding-doctors who previously have enjoyed the ease and legibility of pre-printed order sheets, digital order entry has been disastrous to schedules.

Physicians know that better exists. They have experienced Google, Amazon and e-Bay. Game lovers know that Electronic Arts’ “Tiberium,” now 15 years old, exceeds the capabilities of their professional health care software. They know from Yahoo and MSN the value of configuring a home page suited to delivering niche-information of their own preference. They know from using Word and Word Perfect that they can create precision documents merely by tweaking a template. They know they can use voice commands to make a phone call on their Blackberry. They know that they can find drug information more easily on Google than proprietary software. They suspect that if their EHRs and EMRs had physician-specific home page functionality, that they could drop and drag orders, answer FAQs, dictate letters, and save time with templates with many fewer clicks. Ordering medications should be as safe and uncomplicated as using E*Trade.

Today most EHRs and EMRs are invasive both to workflow and finances. While high cost is a significant barrier to physician adoption, workflow disruption remains the killer deterrent. Most proprietary softwares offer a limited palate of practice options, mostly one does things their way. I recently went to the site of a web-based “Health-e-EMR” provider and watched the flash video demonstration. The demo patient, a return visit for an office visit, was typical enough: an obese, diabetic female smoker with a pulmonary problem. Everything was point and click: select, enter, click, read, post—again and again, over and over. The visit timed out at 30 minutes (their calculation, not mine) not including the time spent by a nurse’s clicks and front-office clicks. Allowing for physicians’ differing styles and based on difficulty, I’d expect this visit to take half that time. The record created was excellent. In private practice, at two patients per hour, and at this level of complexity—say 12 to 14 patients per day—one should expect bankruptcy. One would make a better living running a Dairy Queen. The moral may be that such software should be used only by physicians on salary. Also, many doctors do not want to sit in front of a patient looking into a laptop rather than the patients’ eyes. And they suspect that, if vendors respected service and product improvement as much as chasing new sales, their complaints would result in minimally invasive software.

A sign at a dry-cleaner’s shop reads: Low Prices, High Quality, Fast Service: Pick One. The point of EMR design is not to “pick one.” And, I am not advocating modeling medical practice after that in a remote mission clinic where the only record is a toe-tag, although I should recognize that mission outcomes are remarkably good. In the real world you get what you measure. If the metric is the chart, and you are willing to sacrifice time, then have at it. Also, in the real world, physicians are not usually on salary with no increment of production payment. Physicians do not hate high-tech and they do not hate computers. They hate wasting time; they cannot afford it, and neither can our health care system.

Let me close by saying that the federal software stimulus will be good only if the government standards ultimately endorsed, properly guarantee interoperability and avoid paradoxically funding software that is not only too expensive but that also create silos of proprietary isolation. Properly begun, stimulus is likely to fully return government’s investment through efficiency—not immediately, but over several years. Our office covered EMR acquisition in about 5 years. We did not spend $44,000 per physician. As best stated by M. Lynn Marcus in the MIT, Sloan Management Review, “The Magic Bullet Theory in IT-enabled Transformation,” we confirmed that the key to physician satisfaction is flexible software that does not dictate workflow choices. New software is not the goal; the goal is an information system with a good measure of flexibility. To perfect this system, one will need to reserve a measure of their stimulus funds for training, equipment and employee re-tasking. The good news is that after a period of adjustment to accommodate differing practice styles, one creates a shrinking record room, no piled charts, and fewer employees or employee hours spent finding, pulling and re-filing records. And one finds many unexpected conveniences. One cannot put a price on taking call from one’s home with rapid web-based access to the patient’s office chart at 2 AM.

  • Rich Olson

    This very well written version of the reality of EHR to the physicians work world is consistent with our experience. The vendors come in speaking about ‘change management’ which is code for deflecting real issues raised as busy doctors find no help from the expensive new IT purchase. Many if not most of us MDs know, use and enjoy the good geek stuff out there, yet work with old tools: pre-internet beepers, fax, pen & paper, and confining software applications.
    The good news: the best is yet to be created, if only we MDs can participate in the design, creation and marketing of the killer medical app of the future.

  • http://medtechiq.ning.com/ Conrad Clyburn

    Thoughtful and thought provoking. As advocates of health information technology we need to be mindful of the challenges ahead to intelligently take advantage of the benefits Health IT offers. Thank you.

    I am going to link to this post. I am sure that readers at MedTech-IQ will find it enlightening.

  • http://www.thesystemmd.com. Deane Waldman

    The above remarks are right on target.
    That comment comes from a practicing MD (for over 30 years) in both private and academic [hospital-based] practice. Also from a medical (MD) and management (MBA) academic and researcher with emphasis on systems thinking.
    Bottom line: the EMRs are about as user-UNfriendly as anything you have seen. Example: the screen on which I am supposed to approve and sign my consultation letters has 74! icons or pieces of information. Who can possibly read much less comprehend this sea of irrelevant data?
    All the EMRs make our lives more not less difficult and ARRA 2009 will not make things better, not wil its beefing up security for HIPAA. HIPAA, for instance, prevents me from emailing my consuklts or sharing data about patients, to solve unanswered clinical problems. “Not HIPAA compliant.”
    Practicing doctors would welcome EMRs designed by the same people who programmed i-phones. Instead we got programs where you cannot read the X-ray report and the x-ray itself on the same screen.
    Whatever the computer programming antonym for elegant is, that describes what we have for EMRs.
    PS. I have 14 different passwords for the various programs I am supposed to use every day. “You must change your passwords every 3 months to something new, and oh, you must not write them down!”
    Signed, a very frustrated trying-to-practice-good-efficient-medicine doctor.

  • Rob Huffstedtler

    It seems to me that HealthCare IT has been slower to embrace the value of usability research and good user experience design than IT in other industries. I led a selection on a radiology information system about a decade ago and almost every product required the clinician to navigate to multiple screens during any task, each of which contained a great deal of data that was not needed most of the time. From what I’ve heard, the situation has not improved much in the last ten years.

    Another challenge that may be more difficult to solve is that some of the projected benefits of EMR adoption don’t take effect until later on in the process value chain. There may be situations where a slight drop in efficiency in one part of the process leads to a better overall outcome, but that’s not much consolation to the clinician who suddenly finds his/her job harder and isn’t directly reaping the benefit. A good EMR would mitigate that as much as possible, but care would also need to be used during rollout to recognize any of those impacts that couldn’t be mitigated and to shift staff levels or incentives appropriately.

  • http://hitechplus.blogspot.com/ John Odden

    Dr. Cast indeed tells it like it is. When software (in this case that long-awaited EMR) is purchased at ‘an affordable price’ (meaning the all-in price of getting to daily use), then the physicians are hammered with low productivity. And the price of software tailored to EACH physician is out of reach. We need a model for success here.

    Look at cell phones. The product managers all try to define and build to a feature set and user interface ‘that enough customers will buy’ and they all realize market share will be pretty low compared to automobiles or dishwashers or CT scanners. Customers pick one that comes closest and live with it. Members of a ‘family’ may well all pick different cell phones.

    Hmmm

    Maybe cell phones are a better model for software geeks to attack the EMR opportunity?

    Recently the focus is shifting to Apps Stores for cell phones.

    Maybe we need Apps Stores for EMR User Interfaces that are EMR agnostic. Pick an EMR that talks to local payers and clinical associates. Let each physician use a front end that works for their specialty and style.

    Hmmm

    The Apps Store concept is big in cell phones and not quite so visible (yet) the EMR software industry.

    Perhaps cell phones and Apps Stores could save the EMR industry from the urge to hold costs down by destroying physician productivity as a ‘side effect’ of capturing ARRA HITECH bonuses? Software geeks focus on EMR core services and informatics. Cell phone geeks work on some UI’s for physicians that aren’t ‘*$^*’ (or whatever Dr. Cart said). After all, cell phone User Interfaces can almost be used while driving a car. And we have feedback that some traditional EMR User Interfaces are frustrating to use sitting or standing indoors…

    Nice blogging, Shahid and Dr. Cart!

  • Andy Kett

    Great blog – very informative and well written.
    The views shared on Physicians and IT use are very poigniant – they dont all hate it.

    An EMR / EHR can provide additional information and health care management tools that paper can’t – but sometimes, as described in the post, use of an EMR will take the Physician longer.

    Someone has to pay for that !
    If EMR adoption is going to work, Physicians have to be compensated during early implementation, such that their salary does not ‘drop’. This is where government can help if they are serious about EMR adoption.

  • http://www.practicefusion.com Glenn Laffel, MD, PhD

    I’m the Senior VP for Clinical Affairs at Practice Fusion, which offers a web-based EMR for FREE to physicians.

    Because we are Web-based, we can release new versions of our EMR quite rapidly. We normally do so twice per month.

    Among the 17,000 physicians that have signed up to use our EMR, there has evolved an inner core of intrepid, creative, super-helpful providers who have been flooding us with emails and other communiques about how we can improve our system.

    The Web-based development environment lets us do just that. As a result, our EMR is becoming more intuitive, more integrated with work-flow and flat-out cooler with every release.

    Web-based development platforms such as ours might just be a big part of the answer Dr. Cast has challenged our industry to provide.

    And we can verify Dr. Cast’s assertion that there are a whole heck of a lot of physicians out there who have great ideas about how an EMR should work, who are quite willing–eager even–to share those ideas, and who get a huge kick out of it when they see that their idea has made it into a release, sometimes just weeks after their suggestion was made.

    Glenn Laffel MD, PhD.
    Senior VP Clinical Affairs
    Practice Fusion
    Free, Web-based EMR

  • Nassib Khanafer

    The impression I got after reading this article regarding implementing information technology in healthcare is negative.

    It is very disappointing that there is still resistance in the healthcare to adopt information technology, a technology which has fundamentally changed our life to the better.

    Take a look at information technology in the radiology departments. PACS changed the way radiologists read their studies. Today, it will take minutes to provide a patient radiologist report vs days prior implementing PACS.

    Despite all the challenges in implementing and using IT product, it is far superior system to the current paper based system.

  • http://www.design-outloud.com Phillip Hunter

    As a user interface / user experience designer, this post and the comments are fascinating and a hoped-for confirmation of the offerings I’ve seen. I’ve been surveying EMR/EHR software as part of a medical start-up project and for my own education (and for opportunities). I have not been able to believe how bad *most* of it is. Not just frustration-inducing and time-wasting, but even qualities that I think would reduce the level of care provided.

    If you read this and offer EMR/EHR or any kind of medical software, you need a designer to help you if you don’t already have one. The investment will pay for itself over and over again.

    Phillip
    phillip@design-outloud.com

  • http://healthtrain.blogspot.com Gary Levin

    I think you have hit the nail on the head, and make this all perfectly understandable, except to the politicians….

  • Gail

    The problem obviously is that doctors simply do not have time to do their own data entry. The only possible answer is to have staff do the data entry … perhaps an out-of-work medical transcriptionist …?

    Why should the doctor, whose time is worth at least $300/hr, be doing his own data entry, when he can pay a clerk/MT $15/hr to take this burden off his shoulder? Pretty obvious answer, isn’t it?

  • ConcernedPatient

    Gail,
    The last thing I want is a clerical person with mininmal medical experience entering my meds, seeings alerts and making judgements on what is right and wrong. I want the person responsible for my care with the experience and credentials to be the one navigating the system and making the correct choices.
    I also like the fact that my MD uses voice recognition and dictates his notes while I am in the office. He’s already meeting the suggestions of the HHS by including me the patient in my care and planning.

  • http://goomedic.com Hamza Mousa

    @ Gail ( comment #11 ) :

    I agree , why the doctors should do their own entries , but somehow doctors deal with HIS / EMR every day . the point is , which type of users they used to deal with the system .

    I believe Web based EMR is solving most of the issues mentioned in the article here . especially the web based means :
    1- The developers and the company will be more involved in updates , upgrading the system more than before .
    2-fast upgrade and bugs fixing progress
    3-No need to mention Web based EMR can use the advantage of Many interfaces plus its simple Web interface ( No one can’t handle a website ) and portability ( such as porting the application to iPhone , Android , etc ….)

    However Web Based EMR and medical application are more reliable than the desktop or server-client solutions .

    I have a suggestion to doctors who want to try EMR ,they should give a TRY to open source EMR in the same category of EMR they want to buy . thats will not give them the experience they need but will give them the right impression about the tool they will use .

  • http://lawrence@desanbor.com lawrence a saltzman

    All very well said. This has been touched on from a couple of angles on the blog; US-Canada Health technologies; One piece in particular is;
    http://uscanadahealthtech.blogspot.com/2009/06/seven-myths-of-healthcare-technology2_05.html
    That said, that things like Google and Amazon are out there, with millions (or even billions) of dollars in development behind them does not make such interfaces or facility “off the shelf.” Unfortunately, HIT vendors try to make medical professionals accept things off the engineer’s shelf instead of learning what’s on the provider’s…

  • http://www.desanbor.com lawrence a saltzman

    All very well said. This has been touched on from a couple of angles on the blog; US-Canada Health Technologies; One piece in particular is;
    http://uscanadahealthtech.blogspot.com/2009/06/seven-myths-of-healthcare-technology2_05.html
    That said, that things like Google and Amazon are out there, with millions (or even billions) of dollars in development behind them does not make such interfaces or facility “off the shelf.” Unfortunately, HIT vendors try to make medical professionals accept things off the engineer’s shelf instead of learning what’s on the provider’s…

  • Ray Simkus

    Well said. This article summed up a lot of the issues that have been around for a long time. I completely agree with the sorry state of the functionality of EMRs. I think that part of the problem is that the EMR developers have not been talking to the right people. Typically they will collect advice from a few physicians and often the advice they get is that the docs want something simple and this is what they develop. Having been involved in this field for over the past 25 years I have seen the same problems surfacing over and over. I have seen solutions developed that are completely ignored by individual developers.

    Physicians that are interested in this area should have a look at the work that has been done by various standards groups. If the EMR vendors would develop products based on these standards rather than trying to build some home made product we would be much farther ahead. Things that are discussed at the informatics standards levels are about 10 years ahead of the products that are on the market now. It would be nice if the physicians and the developers paid some attention to the work that has already been done. It would make everyone’s lives easier.

  • Coke R. Smith, MD

    ‘One cannot put a price on taking call from one’s home with rapid web-based access to the patient’s office chart at 2 AM.’

    You are sick.

  • http://www.kgnconsultants.com Kgn Consultants

    Its almost here we are working on just this type of project. Being that we are in Houston you can understand how the medical field has had an impact on our company, everytime we go out doctors, and healthcare management ask us the same thing & they all want the same thing simplicity and access. Frustration from them was the first response when trying to sell a document management system, until we consolidated it with training and support this was the only way to ensure the customer was happy, so we are now working on integrating and rewriting software we used to just sell without support, into something they can work with without having an IT degree do go along with thier MD.

  • J_Lyons

    Dr. Smith #17…I’m puzzled by your comment that Dr. Cast was “sick” for making the comment about being able to take an after hours call from home at 2:00AM, and having immediate access to the patient’s chart without leaving the house. It appears that he was able to immediately support the patients need without even leaving the house. That’s a pretty nice advantage.

  • http://www.hit-usability.com User Centric

    We at User Centric are having a conference on HIT Usability on September 3rd in Chicago about this very topic. Visit our website at http://www.hit-usability.com for more information

  • http://www.dysmd.com jeff delson,md

    There may be another way for physicians to teach their patients to maintain their own records. WE are experimenting with this at dysmd.com where patients come in with their own “I don’t Know letter” which the physician or the staff updates and the patients put in their own information. It may not be for everybody but it is something to think about.

  • emrdiffident

    Nice post, very wonderful. We have eclinicalworks which is supposed to be one of the best, and in my limited experience it is. It’s still awful. Most of these programs hark back to the DOS era. They are unstable, crash prone, and not really designed with work flow or improving patient care in mind. It’s almost as if while the whole program structure were obsolete or rotten, there seems to be a long steady stream of little fixes that basically ignore the obvious: the program is still rotten to the core.

    After my experience in private practice, which led to many people actually quitting our group, I wouldn’t recommend any of these programs. We are still a few decades away from EMR’s actually being useful, and for all the IT hoopla that most of these (unproductive) charlatans pandering these systems make, there is still an elephant in the room being ignored: the ability for these systems to talk to each other.

    Well written piece, just wish I knew what this article was writing this BEFORE we had taken the plunge: that doctors are not adopting EMR’s not because we’re dinosaurs, but because the EMR’s themselves are dinosaurs. If they were really helpful, as a profession we’d be flocking to them just like we flock to all the other electronic toys that have made such a positive difference in our busy, productive lives. Little surprise no one wants to use them; I post as a warning to anyone silly enough to still want to buy one: STAY AWAY!

  • Andrew Hall

    The other major obstacle I have, as a practice manager/ex-IT/data person, is that these programs are not truly data, but an electronic version of a chart.

    Part of it is that the companies have attempted to port the chart mentality to the program, but the major problem is that there is no standard for data interchange. We get results from many different labs, all in different forms. Maybe a few will be integrated electronically, but most will end up having a static page of lab values (often scanned!) in the record. The true power of actually having electronic data to search, compare, etc is totally lost.

  • http://algosysinc.net Arvind Goudar

    Excellent article !!
    We are trying to get into this area and as a Systems Analyst, my first meeting with a doctor ( which I finally earned the hard way) confirmed what you have written.
    It is so wisely said ” the most ingenious solutions are the most simplest ones..”
    Wish me luck …with my years of experince in the IT field, I think I will still need it.

    - Arvind Goudar

  • http://www.clickrich.co.uk ClickRich

    A great article. I work with doctors and EMRs every day and this is the most lucid account of clinicians’ attitudes which I’ve heard or seen.
    I think healthcare software needs to be rearchitected. At the moment it almost entirely is “monolithic”. That is to say that the data and logic is rigidly tied to the user interface and the latter is compromised by the former. We need to seperate them out and give the user interface designers the freedom to do their work.

  • CDanis

    After reading this article I began to have a greater understanding of the physicians point of view regarding IT/ EMR. I agreed with most of what the article was stating. For example these new systems need increased input from its users, such as the physicians and nurses. Also there need to be more steps in place to really make the transition of EMR implementation smoother. Because it does slow down productivity and may be costly. This article should copied or sent to all the major vendors and developers of these programs/ softwares. So they can improve the programs to tailor it more to the clinicians and not the healthcare organization.

  • Jon

    I don’t know if docs hate EMRs or not from a broad perspective, but this article is interesting about a health plan with a unique digital tool to help docs better manager Medicaid patients. I know that’s a big concern among doctors…how to keep better tabs on the health of Medicaid patients:
    http://ourhealthcaresource.com/2009/08/18/physician-know-thy-patients/

  • Michael Kirsch, M.D

    EMR likely means emailing with patients, another free service for physicians to give away. See http://www.MDWhistleblower.blogspot.com

  • http://rx4it.wordpress.com John Delcalzo

    The problem of “user experience” or speed of access to eHR has been a problem that Hospital IT departments often overlook and it often comes from overworked, under-funded IT departments that are trying to learn how to implement an eHR on the job.

    We’ve actually seen the eHR actually add up to 90 minutes to a physician’s day. And no doctor can afford that.

    A little bit of time paying attention to how long the doctor actually takes to get into a system, remember 12 passwords and then navigate through a patient record are the key issues most IT Directors doing eHR for the first time tends to miss.

  • Jack Shaw

    Knowing nothing of medicine other than having been occasionally ill, but having spent a lifetime (40+ years) in IT, there's nothing new in the laments of Dr. Cast that hasn't been repeated umpteen times since I was in the trade — and probably 100 times that since the inception of Babbage's engine:

    1. Prospective users aren't consulted as to their requirements and the variables in their clinical/administrative environments.
    2. “Innovation” and other cleverness takes precedence over (very likely ill-defined) standards, leading to incompatibility between/among components and systems.
    3. Users — not developers — need to test the systems in their working environment against measurable standards of performance.

    In “Quality is Free”, Mr. Crosby defined the highest quality for piecework and manufacturing as “zero defects” — rework to repair imperfections costs more than assuring those imperfections don't occur to begin with. More importantly for quality in processes and systems, quality's highest measure is always in inverse proportion to the degree of “deviation from requirements”. Ergo, the energy spent to thoroughly and accurately define the requirements is the best ROI for obtaining the desired quality.

    And it's the also the greatest guarantee of avoiding “GI” and the inevitably resulting “GO”.

  • Lisa Breza

    Mr. Delcalzo,
    As a CNO I sit on many committees and tasks forces with physicians. We are in the process of fully implementing CPOE. Recently, I had a physician, who is techno savy, and one of the leaders in our organization who brought up the exact point you made. His group has a high volume of patients in the hosptial daily and routinely one of them rounds in hospital. He indicated that the computer takes 2-3 minutes more for each patient and if he multiplied that by his volume, by week, he has added more time to his work week. Although he wants to be supportive, and perhaps may see the long term benefits, he finds it counter productive. Add to that the system being slow, we now have an irrate physician calling administration complaining. Not to mention he has now gotten his colleagues to support his negative experience and wants to know what's in it for him to continue.

    As you posted a few months ago, have you had any luck in improving efficencies for physicians to avoid discouragement on their part. As I understand their argument, I want them to see the long term benefits and prevent them from discouraging other physicians.

  • http://www.implementhit.com/ EMR Medical

    i can't agree with you.. Nowadays many doctors are now taking advantage of the internet to conduct web consultations. we able to access patient data from anywhere in the world via a secure connection even allows the doctor to conduct web consultations or generate reports from home. Health maintenance reminders that can be automatically generated from an EMR system also contribute to providing improved patient care.

  • http://www.implementhit.com/ EMR Medical

    i can't agree with you.. Nowadays many doctors are now taking advantage of the internet to conduct web consultations. we able to access patient data from anywhere in the world via a secure connection even allows the doctor to conduct web consultations or generate reports from home. Health maintenance reminders that can be automatically generated from an EMR system also contribute to providing improved patient care.

  • http://www.talkstandards.com/ Mattias Ganslandt

    The European Commission’s Communication on Cross-border Interoperability of Electronic Health Records called for action to support a wider understanding of interoperability amongst key stakeholders. It has therefore funded a Support Action to promote interoperability among personal health systems and to other eHealth systems. The SmartPersonalHealth project started on 1st of January 2010 and will run for one year.

    We want to discuss some of these issues at the upcoming online forum about eHealth and standards on February 25th, 4-8 pm GMT on http://www.talkstandards.com which will raise some of these points and hopefully contribute interesting insight into this fast moving sector.

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  • http://twitter.com/Ssingh29Kumar Suraj Kumar

    Suburb answers. US Gov wants doctors data entry operator.

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