In the comments of a previous post Fred gave the following advice about your IT support during an EMR implementation, “you can pay a little more upfront and be done with it or pay more over the long haul and never be happy.
My only caution with this is advice is that paying more isn’t always better. This is particularly true when you’re talking about what you pay for the advice you get from an IT person. However, I think Fred’s point is that if you scrimp on some of the technology up front it can come back to haunt you. Regardless of how much you pay, you need to make sure your IT person knows what they’re talking about.
An example of paying too little up front is if you purchase a computer with too little RAM. Some things you can cut back on. Feel free to get a smaller hard drive. Do you REALLY need the DVD burner with Blue-ray? Usually not, but skimping on something like RAM will make you miserable. Then, your computer will slow down your EMR and your next call to your EMR vendor you’ll say, “Your EMR is SLOW!!!” when in fact it’s just you spent too little money up front on the important things.
I wholeheartedly agree with this post. As an EHR vendor, we see many physicians who are on a budget. We designed our software to run well on older hardware, so our customers don’t really have to go out and buy the latest and greatest. We have also had good experiences with refurbished computers in some cases – provided you upgrade the RAM.
I will also concur about computer problems vs software problems. People who aren’t experienced with computers may not be able to distinguish between the two. If you throw in a completely new operating system like Vista, that can compound the problem and make the learning curve a little steeper.
There is a great deal more to the usability of the EHR than the hardware configuration of the client machine. Many of the software products are overly complex, enable poor human-computer interaction, and force the clinician down arbritrary pathways. In virtually no other “industry” would this have been tolerated by users.
Dr. Higgins,
You’re absolutely right. Many EHR software are horribly unusable even with the right IT support. However, even a well designed EHR can suck the life out of your EHR initiative if the IT part is done poorly.
I would suggest that provenance is also an extremely important aspect to consider in the selection of software for your office. Consider carefully who has designed the software and where it’s emphasis lies. Software driven by insurance company reporting functions does not likely implement workflow and usage with quality of patient care and ease of use for the doctor in mind.
The drive to codify everything to a numeric slows users and represents an aspect of the implementation of an EMR that is guaranteed, by and large, to cripple productivity. Codification has it’s place in research but a physician’s greatest motivation is to provide care and advice to his/her patients and to either cure, treat or help the patient to cope with their disease.
Front line care should not be co-opted into tedious data capture codification to serve the bean counters and claim processors of the insurance industry.
As for the right sizing of equipment specs, this must always be made clear by the EMR vendor and a careful analysis of the client’s needs. Memory, storage and even screen sizes need to match the purpose. At one time, LCD displays were well over $1000 and considered to be far too expensive to use in an examining room – until one considered the leasehold improvements needed to accomodate a 17″ CRT in a too small exam room or the poor experience and/or loss of productive time for the clinician.
Frank,
It’s not just insurance companies that want data codified. Also the government (public health and Medicare stuff) and for research. The challenge is codifying it enough that you can meaningfully exchange the data between 2 systems, but not over codifying where it impacts the workflow of the doctor.
John
I do realise that. I have been involved in the sales, installation, training and ongoing support for EMRs in doctors offices and clinics for over 20 years in Canada.
The software I have represented has evolved from billing only to appointments, and eventually EMR fully integrating internal messaging, task assignment and tracking, drug interaction, patient handouts etc. All this has been offered from long before there was any subsidy from any government.
Developed initially by a family physician, the software was always (and continues to be) optimised for the physicians’ needs and workflows.
About 7 years ago, when Ontario started their first pilot program for primary care reform, the first steps were taken to establish a certification program for EMR software. This standard is now at a version 3. Each new version has raised the bar for compliance and data exchange. Along with each new spec, came greater and greater demands for “features” that are of far more interest to the government that for the practical daily needs of physicians.
There are certainly some extensions to the specifications that are beneficial to physicians. The trick is, as you note, to ensure that the software usability doesn’t get overwhelmed by the demands of those external forces.