EHRs Uninstalled in Phoenix a Glimpse into the Future? – Guest Post

Our next guest post comes from Ryan Ricks of XLEMR. In this post Ryan compares the ARRA EHR stimulus money with Governor Napolitano’s mandate to adopt EMR software in Arizona and the alarming EMR uninstall rate.

The HITECH Stimulus Act is part of President Obama’s plan for full, nation-wide use of EMRs by 2014. The act promotes Electronic Medical Record (EMR) adoption by allocating funds to reimburse physicians for purchasing and using a qualified EMR system. In addition, physicians who fail to adopt an EMR will eventually face Medicare reimbursement penalties. Although the goal is lofty, Obama hopes the act’s carrot and stick approach will encourage physicians to adopt EMRs.

However, a recent report by HealthLeaders-InterStudy indicates that Phoenix, Arizona is experiencing a high rate of Electronic Health Records (EHR) uninstalls. According to the report, the trend is due to training, functionality, or affordability issues. Both top-level hospitals and smaller providers struggle with the financial constraints of purchasing and implementing EHR systems. Arizona rapidly adopted EMR systems due to a 2005 executive order by Governor Janet Napolitano, which required that all healthcare providers install an EHR by 2010.

Does this uninstallation trend provide us a glimpse into the future? Will the U.S. share Arizona’s experience at the national level? Arizona’s executive order is similar to the HITECH stimulus act because both seek to rapidly drive EMR adoption to meet an arbitrary deadline. In both cases, physicians feel pressured to make a very important and potentially very expensive decision. Although EMRs provide many benefits, selecting the wrong system, or rushing the implementation process could lead to many problems. It seems that Arizona physicians are scrambling to remove unusable systems due to poor selection or botched implementations.

This does not necessarily mean the HITECH Act will fail. Rather, it means that physicians need to be careful and not rush into a decision they may regret. EMR system prices can reach $100,000 or more. In contrast, the stimulus act will only pay about $44,000 in reimbursements. Physicians should focus on their needs, not wants or superfluous features, and select the simplest system that fulfills their requirements. Simple systems are easy to install, easy to learn, and easy to use. Ease of use is critical; complex and difficult systems can lead to spiraling maintenance and training costs, and may ultimately be discarded.
The uninstallation trend in Arizona is a clear warning. Although well-intentioned, the HITECH Stimulus Act may encourage physicians to rashly purchase a system that will not work well in the long run. Physicians must resist the temptation throw in a system just to qualify for reimbursement payments. Instead, they should take their time to find a simple, user-friendly system that meets their needs. After all, $44,000 sounds like a lot of money, but it will probably not cover the more expensive EMR systems with monthly maintenance fees.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the, 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,, 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.


  • The recommendation to purchase a “simple system” does not guarantee you will get a system that is easy to use, easy to learn and easy to install. I have seen implementation, functionality and workflow issues with both simple and complex systems.

    The answer to this enigma is to properly PLAN for a system solution. The planning stage takes at least six months and includes a strong focus on mapping out essential requirements of the EMR for a given provider environment. Most implementations fail because the planning stage was grossly compromised. You cannot select an EMR provider based strictly on cost or “simplicity” alone. Just like any other investment strategy, you will need to allocate funds at an appropriate level to meet essential needs and then control the cost during the implementation, holding the vendor (and other stakeholders) accountable for adhering to a well thought out advance plan. Deinstalls of EMRs are symptoms of poorly planned projects. I would strongly recommend contracting with a seasoned and reputable HIT consulting firm very early in the project conception phase. If nothing else, this will reduce the risk of formulating a faulty project that weighs too heavily on low cost, unproven vendor claims, or poorly designed workflow.

  • Tom,
    The key for me is that finding the right system can make many of those workflow issues easier to resolve. However, your point is well made that even the very best EMR software is not perfect and will require good work flow planning and even plenty of give and take to make them work properly in a practice.

  • John et al,
    Besides workflow, We really need to consider the whole system. That is what makes finding the “right system” difficult. Besides the workflow, you need a system that is dependable is several key areas:
    1) guaranteed 99.9% uptime. This can be affected by the software, hardware, storage architecture, network.
    2) Consistent performance. Latencies during database calls, display renderings, high usage times, etc. can noticeably reduce response times and result in loss of productivity as well as raising user frustration levels.
    3) Support and Maintenance responsiveness. Any system will need highly responsive support processes. This includes internal resources budgeted for, qualified for their role and trained fully prior to Go-Live, a highly knowleadgeable application and technical support team, well documented system operations and use cases, readily accessible help utilities and training materials.
    4) Workflow configuration. Defaults settings are easy but do not work most of the time. Templates are nice but may not be capable of meeting the needs or following your new workflow maps.

    ALL of these areas are mission critical and require solid planning. these attributes may seem easily predictable but the reality is they are not. One cannot acquire the necessary knowledge by simply looking at a product specification sheet or by asking the vendor, Any shortcomings in any of these areas could seriously compromise the ease-of-use and could cause a significant shortfall in productivity not to mention the resulting cost overruns and missed Go-Live dates. If this wasn’t the case, you would not see so many de-installs and EMR adoption rates would be much higher.

    Just like you need a good CPA to ensure your taxes are done correctly, an EMR implementation needs a high quality project management in all the critical areas to keep you on the straight path to success.

  • if providers hire competent it project managers they will be fine. Offer this to skeptic docs – you can pay a little more upfront and be done with it or pay more over the long haul and never be happy.

  • I think way too much focus is given to the reimbursement portion of this process. It is a necessary tool that doctors will be mandated to use in the future.
    When I was in the printing industry we bought million dollar machines just to compete in the marketplace. There was no reimbursement on the table.
    I realize it is not a really great parallel comparison, but my point is, many professions require investment to be run properly.

    The real issue behind the all the hoopla here is that whatever you choose it should have a common sense approach You should also work with someone you trust. It also needs to encompass all your data collection needs going forward and also have logical support for your historical documents.

    Currently my company Media Spiders is providing the historical record support to several doctors with an EMR already in place. Using our open source web based retrieval system for your paper records you can migrate them easily forward as needed into your EMR while keeping the historical records in tact. It keeps you from having to perform the tedious actions of scanning, reclaiming the wasted space in your clinic and eliminating the possibility of loss due to fire , water etc.

    If you plan properly, and start early you can control your costs by setting a monthly scanning budget. I don’t agree with the statement that if you pay a little more upfront and be done with it. How many of us are using the first computer we ever purchased?
    Or the first cellphone?

    This is a migratory industry and we must understand that it changes and we will change with it. The only way to manage the financial pain of that is to get in early with the least amount of commitment to what makes sense to you and evolve with technology.

  • Hi Bill,
    What open source system are you using for your web based retrieval system? I’d like to see what open source projects are out there.

  • Hi John,
    We developed our software initially in 2003 for what was then our our largest client Stericycle. They needed a solution to allow the medical waste manifests they generate to be accessed by their active clients. The reason for this development was government regulation mandates that the original manifest signed by all parties associated with its life cycle get returned to the generator of origin.
    Media Spiders developed, implemented, trained Stericycle employees, and managed this entire process for Stericycle and its clients from 2003 until the December of 2008. For the bulk of those years we enabled Stericyle to gain a huge competitive edge by being the first approved online manifest archive, allowing the elimination the mail-back of manifests in 38 states. Keep in mind we eliminated the mailing and associated labor costs for 60,000 manifests weekly.
    We were scanning between 65-90,000 manifests each week, maintaining access totaling over 2 million manifests. Did I mention any lost manifests or manifest not available in the archive in 7 working days could have created fines with DOT for Stericycle?
    With that kind of volume you can imagine we spent a fair amount of time adding and fine tuning our code, equipment and procedures to be able to perform for our client.

    Our software is developed with SQL-HTML-PHP-AJAX and JAVA scripting. it easily augmented to fit each clients needs. We can roll out an online archive in a couple of hours that is branded to match the doctors web presence and it can be housing scanned images immediately. All archives have multi level access and are hosted on enterprise level servers with full back up procedures in multiple locations.
    We allow up to 25 user access for $69.00 per month.
    we scan at .06-.085 per image depending on the level of document prep. This price includes local pic up and return of records.

    We are currently working several doctors, one that is just putting in his EMR and our software and service is a perfect fit for him. It allows a centralization of the archived records. They can be accessed from either of his practice offices as well as from home.
    It also allows him to migrate the active patients over to his new EMR in form a central point from either office maintaining a continuity of his historical records while staying in control of the migration.

  • Good morning John,
    Although our software is developed in open source technology, it is not an open source project.
    It is not available for anyone to contribute to.

    Sorry for any confusion.

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