Replacing an Existing EMR

I received the following email from a reader of this blog:

I am the manager of a 2 physician, 2 nurse practitioner practice with an 11 bed sleep lab. We purchased our EMR in 2006, without much research, because it was compatible with our billing/scheduling program. It is grossly time consuming. Just entering a problem list takes 5 steps (for each disorder we are entering). It will not create notes as many EMRs do. We dictate notes to a transcription service and they are uploaded as documents. Basically it is a non-interactive storage unit, much like our paper charts were, except more time consuming. The company has basically told us that they will not be changing the system. The doctors and NPs are nearing revolt at this point because of the time that they spend trying to use this system.

What is your point of view on finding a new EMR? What would the time and mental repercussions be? Is it possible to coordinate billing systems and EMRs from different companies?

My reply was something I thought many on this blog would benefit from:
Thanks for sharing your experience. Unfortunately, it’s a common one.

The good news for you is it sounds like the notes in your current system is basically a document management system that stores your transcriptions electronically. This bodes well for you if you decide you’d like to move to a new EMR system. I say that because it is likely that you’ll be able to get these documents out of your old system and import them into a new EMR system so that your old EMR records are still available in the new EMR. Many EMR companies will work with you on doing just this.

If your current EMR system is worse than paper, then it sounds like change is likely a good choice. What I think you’ll find is the lessons you’ve learned from this first implementation will help you in your next EMR selection and implementation. It’s unfortunate you had to pay that price, but now that you’ve learned you might as well use it to your full advantage, right? In business they call it a sunk cost. It’s time and money already spent. You should base your decisions on changing your EMR on the time and money you’ll have to spend going forward and not costs which you’ll never get back.

It will take some time and money to fix it. However, those people who dislike your current EMR might be ready to commit the time and money needed to find a good EMR to replace what you’re using now. I will also say that I think unhappy workers is worth spending a lot of time and money to fix. An EMR should not start a revolt.

My only caution for you is that you need to take a real serious look at your clinic and ask an important question: Is it the EMR that’s the problem or is it something about our workflow/clinical environment/policies/culture that is the real problem with the system? Obviously, if it’s the former a change of EMR would be good. If it’s the later, then you might as well not change EMR software until you fix those other issues. I’ve often said that implementing an EMR just exacerbates any problems or weaknesses that exist in a clinical environment. It brings them to the surface and makes them hard to ignore.

Yes, there are a number of EMR companies that will work with your current Practice Management System (PMS). I’m someone who believes that if you’re very happy with your current PMS and the reimbursement that you’re getting from it, then it’s certainly a reasonable option to stick with your current PMS and interface it with an EMR company. In fact, there are some companies that are only EMR companies and then interface with various PMS systems. Their philosophy is that they should just focus their time on making an excellent EMR and not divide themselves between EMR and PMS software creation. Basically, they let another company focus on making an excellent PMS (or they’re are already excellent PMS systems out there). One example of this is Medtuity which is where I learned some of these principles. As I look at their product, I can see the advantages of focusing on being the best EMR and not being distracted.

Just know that there are costs associated with managing/supporting an interface between your EMR and PMS. Plus, there are some advantages to having the two integrated. You should weigh those out as you select a new EMR.

This was kind of fun. If you have a question you’d like me to answer, send it to me on my contact form and I’ll see about making it a future blog post.

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.


  • While generally I believe the insights you’ve shared are accurate, I do believe there is one significant one that warrants further exploration.

    It is a distinct possibility that part of the challenges this practice faces with their current EMR is that it is, as you clearly state, not much more than a document management system. As such, moving those documents to another EMR which itself will only attach documents to the record will be, again, another glorified document management system.

    While a lofty goal to be sure, there is a growing base of support for recognizing that most EMRs are not much more than this. And that to realize the real promise of what the EMR can do for all of us (practitioners, patients, etc.) we have to abandon this model, and embrace EMRs which capture data as discreet elements, rather than ‘digital paper.’ Absent this, the EMR will always be limited in what it can do (automated workflows, clinical decision support, etc.) by ‘digital paper.’

    And the transition from this practice’s current ‘document management system’ to a truly robust EMR which does capture discreet data rather than ‘documents’ will not be as easy as you suggest. But the payback will be much greater.

  • Schlomo Gould,
    I think you may have misunderstood my point. My point was that it might be easier to move the records from the old EMR system to the new EMR system. Not necessarily that learning to document in the new system will be easier than their current system. Although, I would suggest that it could be easier if they find the right EMR that is highly usable and yet still capture’s data as discreet elements.

    In fact, it’s funny you say that, because the EMR only that I suggested (Medtuity) is probably the best EMR I’ve seen at capturing discrete elements.

    So, we’re in agreement, but I didn’t describe it well. I changed the wording a little bit to hopefully be a little more clear.

  • John,

    Great answer to this sad situation. If it is an EMR problem and not a “provider” problem, there are many excellent EMRs that this practice should look at. My two favorite are SOAPware and SRSsoft.

    Check out my posts on to see more of my thoughts on these systems.

    Unfortunately, the focus of EMR companies is many times not in the right place. I think the top goals should be: Simple to Use, Easy to Learn, Affordable and the EMR should increase Provider Productivity.

    Dr. Jeff

  • Dr. Jeff,
    You’re right that these systems must do those things to get wide adoption. However, at the same time they have to be scalable for the future so that they can facilitate better care for the patient and make the doctor better than he/she would have been on her own. I don’t think the 2 are mutually exclusive. It’s just harder to find.

  • what defines “easy to use” and “easy to learn”? isn’t it only easy if you have the aptitude for it? i find that many clinicians dont use computers in general outside of a browser and email client. so how simple are we expecting an EMR software to be, whose purpose is to tackle this monster of a thing called patient care?

    if we take 100 bright and tech saavy ppl and send them through med school, i dont think those that make it through will have much problems with any of these systems.

    if we take 100 clinicians and put them through a computer learning course…wait, they dont have time waste on silly things like this. it should take no more than 1 hr training.

    i think there’s this charting competition during some conference where vendors competed in charting various patient visit cases from beginning to end (i think this is a great idea). and then comparing the results to see which was fastest, and caught all the uh-ohs like allergies, drug/drug interactions, etc. it’s amazing how fast some of these clinicians can be, and how much functionalities these systems have. the problem in the short term will always be adoption…and that’s mainly because we have a nation of clinicians who aren’t computer saavy. wait 10 years, things will magically be so much better, not because of technological advances in healthcare software, but because we’ll have ppl who grew up understanding how to use computers.

    there’s nothing THAT special about healthcare software. it’s mostly data input, and data validations. that’s pretty much it. it’s not rocket science (analyzing the data is another story…that’s where the big value add is, but until you go 100% computer, no point in talking about reporting).

    i dont know the authors system, but i’m curious to see what would happen if they go back to paper. i’m willing to bet those clinicians will be begging to go back to computers in a couple weeks.

    we complain too much. suck it up and earn you pay. anyone can make it work, you just have to want it.

  • Peter,
    You’re definitely right. We’d never go back to paper now that we’ve had EMR. That’s why the article’s entitled replace the EMR and not get rid of your EMR and go back to paper.

    I agree with the need for many to suck it up. However, there is also the fact that some EMR require less sucking up than others.

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