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

A friend of mine sent me this link – "Beware of the EMR ‘Ponzi scheme,’ warns physician leader" — earlier this week. The article starts off by saying:

Healthcare IT does not necessarily make life easier for primary care physicians, says a leader in the movement to make medicine more efficient and patient-centered.

"When you put an EMR into a primary care practice, your life is hell for the next year," said L.Gordon Moore, MD.

"EMR vendors aren’t really giving us what we need. We have to make a distinction between a robust EMR with decision support tools, and one that is just being marketed as a way to improve coding. And we really need to get out of the E&M coding game."

Yikes. I’ve been in the healthcare IT market for a while and that’s probably one of the strongest anti-EMR statements I’ve seen publicly.

I know I have many readers who are physicians — how many of you concur with Dr. Moore?

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13 thoughts on “Does putting an EMR into a primary care practice make life hell for a year?

  1. 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.

  2. I disagree with Dr. Moore, at least regarding EMR.

    EMR’s as glorified E&M coders? I suggest he look at them again; the major EMR vendors are all about increasing efficiencies across the entire office, especially with an integrated scheduling and practice management module. And especially where subsidies exist to defray the adoption cost, licensing costs are much more reasonable now than ever.

    Like it or not, there’s a federal mandate to go electronic by 2014.

    Like it or not, the payers are looking very carefully at the numbers — and that means that EMR’s must keep track things using discrete, countable events, like button clicks or choices from lists. Getting pissed at these givens is a waste of time.

    Vendors “making money on the complexity of implementation and training?” Last time I looked, real life and real life medicine were pretty complicated.

    Holding your breath for an EMR that will be nice, simple, interoperable across many disparate health care resources, 99.9% reliable, and — almost forgot this — open source and FREE, and you’ll be turning purple for a really. Long. Time.

  3. 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.

  4. I personally believe that if you weigh all the costs and benefits of EMR it’s probably a wash. However, it does put you on a platform to do new things that you could never even dream of doing with paper. Not to mention various federal mandates and billing requirements of the future.

    The sad part of this all is that many of what I call the “jabba the hut” EMR companies really are a ponzi scheme that wastes a doctors time and money.

    One last note. In my review of various EMR implementations, it seems to me that clinics with poor clinical processes before EMR just maximize those problems when an EMR is implemented. Those with good clinical processes before EMR are usually able to apply good clinical processes to an EMR.

  5. 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.

  6. For those who are unaware, Dr. Gordon Moore was featured in a cover story (US News and World Report – I think) about 5 years ago and heralded as being a new breed of electronic physician with his early usage of EMR. His reversal of opinion underscores the drama and striking challenge of automating the cognitive processes of a medical exam. Our industry remains awash in hype, unrealistic expectation, and even mistruth. Case in point – the post above mentioning “like it or not” the existence of “a federal mandate to go electronic by 2014.”

    There is no mandate to go electronic. This is confirmed by the ONCHIT (US Dept HHS), the MGMA legal department, and the AMA.

    Unfortunately, there are alot of overpriced vendors selling mistruths and unfit products to trusting physicians.

    The lesson for physicians is to hold onto your money until something is clearly useful and guaranteed to work.

  7. 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.

  8. 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

  9. Pingback: Is Using New EMR Software “Hell” For Private Practicioners « Knowledge Storm

  10. 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.

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