Obama and Congressional Leaders Can’t Overlook EMR Failure Rates

“If it’s [EMR investment and implementation] too hasty, you can create so many bad experiences that people say…’My data’s a mess and my patients are angry,'” Mr. Glaser said in a recent Wall Street Journal article on the possible wasted investment in EMR. 

The scary thing is that John Glaser, chief information officer for Partners Healthcare, is probably right.  I know that President Barack Obama wants to “wield technology’s wonders to raise health care’s quality and lower its costs.”  I want to do that too.  In fact, I think we’d all like for that to happen.  Unfortunately, I think we have to seriously ask ourselves if the current electronic medical records offerings can raise health care’s quality and lower its costs.

I think there are two points that have been proven time and time again in implementing an electronic medical record in a doctor’s office.

Point 1: A Well Implemented EMR Yields Great Results – Hundreds (possibly thousands) of doctors can attest to how happy they are using an EMR.  My personal finding is that the key to a successful EMR implementation is deeply related to how well a clinical practice is run before implementing an EMR.  In fact, I believe an EMR will exacerbate any problems a clinic may have been experiencing pre-EMR.  However, many clinics have shown that when done right there are tremendous benefits associated with an EMR.

Point 2: A Poorly Implemented EMR Causes More Harm Than Good – Blame it on the software.  Blame it on the clinic.  Blame it on the technology.  Blame it on the health care culture.  It’s probably a mixture of all of these things that has caused so many EMR implementations to fail.  Regardless of the reason, all of these failed EMR implementations have shown the damage that can be done to a practice that fails in their implementation.  Unhappy patients.  Unhappy and frustrated doctors.  Thousands of hours evaluating, learning, training, testing and implementing down the drain.

It’s no wonder that the New England Journal of Medicine found that only 4% of U.S. physicians were using a “fully functional” electronic health record system.  The huge failure rate among physicians has created a fear in doctors that’s difficult to overcome.  Sadly I think it might take a generation for doctors to overcome this bias.

The reality is that implementation of an EMR CAN increase health care’s quality and lower its costs.  The problem is that most clinics haven’t yielded these promised benefits and most are living with failed EMR implementations.  The huge numbers of failed implementations can not be ignored.  Ignoring this will lead to even more failed implementations which could set the movement to digitizing patient records back years.

It’s not enough to poor money onto something without looking at and solving the reasons why so many people have failed in their implementation of electronic medical records.

I don’t want to give the impression that I’m not for investment in EMR and health care IT.  I think that help is needed and could be beneficial to the future of health care in the US.  I also really believe that EMR does open up a whole world of opportunities that we couldn’t consider without broad adoption of electronic medical records.  However, I don’t think enough attention is being paid to understanding what factors are important to implementing an EMR successfully.  By understanding these facets of implementation we can invest in electronic medical records that are actually being used and effective.  Otherwise, we’re just lining the pockets of the EMR vendors without any benefits to health care or doctors.

About the author

John Lynn

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • It’s not just “failed” EMR implementations, but also incomplete implementations. Many doctors who might consider their implementation a success have only partially implemented their systems. The up front effort seems daunting at first, but once they are up and running, they stop. They don’t implement certain modules; they don’t add applications or processes to enhance the return (be it improvement to quality, efficiency or profit).

    So many doctors have trouble getting out of the document/paper mindset. They think all they need to do is to get the electronic system to mimic their old paper processes and they are done.

    It may take an entire generation of new physicians to revolutionize the way doctors practice. The stimulus bill can help this along by funding residency and internship programs to train physicians on EMR usage and understanding from the beginning. As these doctors enter private or employed practice, they will be seeking positions where EMRs are already in place.

  • I’d say that most incomplete implementations are basically failed implementations in my book. Although, I think you’re absolutely right about many not taking the next steps and simply modeling the paper world electronically.

    Do you think the stimulus bill is going to fund residency and internship programs to train physicians in EMR usage? I do agree that it probably will be this next generation of doctors that will cause the change to EMR. Maybe we should focus our EMR implementation efforts on students. Although, I’m not sure if you read the study that said that students learning in medical schools with lots of technology find it a challenge to go into the “real world” and practice medicine properly, because they are lost without technology.

    I still say train them on the technology and like you said, they’ll look for positions that already have an EMR.

  • Great stuff here John. Thanks for warning people that EMR implementation has its limitations. With EMR vendors shouting their perfection all over the web, its good to know that people like you are speaking the truth. What do you think is the best way for a practice to ease into successful EMR usage during a long and difficult implementation?

    I figure adopting a standalone e-prescribing system as a steppingstone to a future EMR is an option which should not be overlooked. Standalone e-rx usually requires only minimal investments of time and money, while providing many of the same benefits as an EMR (as long as the practice makes sure it will be interoperable with their future EMR system.)

    What are your thoughts on this?

  • Thanks Irene. I try to be a voice of reason against the everything is perfect with EMR salespeople.

    I don’t mind doing a standalone e-prescribing system as a stepping stone. The problem is knowing that your future EMR will work with that standalone system. Most people have no clue which EMR system they’ll use. Plus, e-prescribing doesn’t dramatically change the clinical workflow the way an EMR will change it. It really only affects the doctor instead of affecting the entire clinic.

    I think the best key to a successful EMR implementation is being realistic in your understanding of the process and being educated on the pitfalls that await you. Far too many people haven’t been given a realistic view and that really causes problems later.

  • (I am employed by DrFirst, an e-prescribing company, so feel free to take my thoughts with a grain of salt.)

    We have seen that e-prescribing does affect the practice workflow, because of the new way (more efficient) way of handling renewals and and the reduction of pharmacy call backs. In addition, the staff has their part in making sure the patient record is updated with the medication history and the correct pharmacy.

    E-prescribing’s medication history, allergy and problems list, and evidence-based decision support tools offer physicians access to the most up-to-date and accurate information possible during the prescribing process, allowing providers to take advantage of the key benefits of an EMR at a substantially lower cost.

    E-prescribing is an easy-to-implement technology and perfect for a physician and their staff’s first step towards becoming acclimated to personally interacting with technology during a clinical process.

    Secondly, establishing how a practice will incorporate technology into their existing workflow is easier with a simpler piece of technology, such as e-prescribing, when getting “buy in” from staff members. Establishing these processes will help ensure a smooth transition into a more complex EMR system in the future. Plus, you get stronger staff buy in to technology when they witness the increased efficiency and greater productivity.

    Plus, starting with an e-prescribing system allows the practice to quickly pre-populate their future EMR. By using a Surescripts Gold Certified standalone e-prescribing solution that has a migration path to a flexible array of EMRs, practices are able to quickly and automatically obtain patient demographics and medication history information, as well as begin populating their allergies and problem lists and interface them or data dump them into their future EMR. (Shameless plug coming :p- For example, DrFirst is a vendor that is integrated with more than 65 EMR companies, and can automatically feed your data to all other EMR systems, providing a smoother migration path of your patient data in the future.)

    (Me trying to be more even handed- Other major standalone vendors such as AllScripts have an upgrade path to their EMR and RxNT allows physicians to interface with some EMRs.)

    Physicians should ask their eprescribing vendor which EMRs they are partnered with or can interface with so they can determine what their long-term technology plan for the practice will be.

    Lastly, with the recent signing of MIPPA and ARRA incentive programs aimed at promoting nation-wide adoption of e-prescribing, physicians can also significantly increase their incentive payments from the govt, while waiting for their EMRs to be selected and implemented- which can be a long process. The bill includes incentives for early adoption as well as small penalties for failure to adopt. The AMA estimates that physicians can receive up to $44,000 over a five-year period for the use of HIT in their practices if they started in 2009.

    Anyway, its good to have people out emphasizing that practices considering EMR/EHR implementations should “Make Haste Slowly”.

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