Convincing Doctors to Do EMR

Yesterday I was attending a conference that had almost nothing to do with EMR. However, in one of my conversations a young girl told me that her dad was a doctor. She went on to tell me how it is all that her dad can talk about her.  He was trying to convince himself why he should ignore the stimulus money and not do EMR.

Of course, this part isn’t that interesting since I think we all know many doctors who are doing something similar. What was very interesting was that the daughter of this doctor explained how she was trying to convince her dad why he should do EMR. In fact, she suggested that she might have read my EMR site before because she’d done searches to learn more about EMR so that she could convince her doctor father to use an EMR.

This discussion of why you should or shouldn’t use an EMR is really nothing new. My challenge with the discussion is that I’ve seen first hand the benefits of EMR. However, I’ve also heard many stories of EMR implementations which utterly failed.

I don’t know all the answers to this situation, but it is something I want to think about more.

I do think that selecting the right EMR is the first step in the process. The other challenge is finding the right person or people to support your implementation.   Now, how do we simplify and improve those two objectives?

About the author

John Lynn

John Lynn

John Lynn is the Founder of the 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.

18 Comments

  • I think one way is to provide simple, easily-accessible resources to physicians who are interested in EMR but are not sure of the benefits and how to solve potential problems that could come up.

    A big first step is just getting the physician to try using an EMR. This would be done in their own time and after some experimentation, they can determine if an EMR is right for their practice.

    I tried this with an older private peditrician who mostly has Medical patients and it worked. It took a lot of support, but he eventually realized the benefits of EMR.

  • Stanley,
    Nice point. I agree that getting them to use an EMR is a good idea. It’s hard to compare to really touching and feeling something. This is one reason I love the various free EMR software or other SaaS EMR software. You can usually get in and use the full EMR software to test it out.

  • The common response I’ve heard from Physicians is that the task of selecting an EMR seems very daunting. Not knowing where to even start is the first big hurdle. Another is the reluctance of “window shopping” because the only way to see and EMR is via a sales rep demo. The demo works well to show the benefits/features of the EMR, but the downside is that then you’re a verified target of the sales reps, and can expect calls/visits from each one you contact. I think that some physicians would not rather go down that road until their path is more clear.

  • Almost every EHR onthe market “works”. Most just have too many features, or custimzations that are too hard to learn at one time. Implement and do eRX on day one? Nope. Maybe they will had eRX after they figure out how to see a patient, but where is the trainer than? Gone.

    Ongoing support is critical to success. Finding a IT vendor or IT person that understands HIT, is paramount to success.

  • Almost every doctor I speak to is considering an EMR, but have heard these same horror stories about problems encountered and that the systems slow them down. I have worked with many practices that have improved their patient flow significantly, but have also run into a few problem implementations due to culture, poor selection, and even in one case a buggy release of a great EMR (Murphy’s Law).

    Also, as I wrote in am article for http://www.movetoemr.com about a smaller segment of practices that are already running a legacy EMR. There are challenges there as well (migration of data, retraining, the one feature they really love about the old one, etc…)

    Its going to be a long bumpy road (way more than 5 years) helping practices through the transitions.

  • Again the question is phrased wrong. If EMRs were better for doctors and patients, and easier to use, we would all be doing it. We’re talking about an industry that is always pushing the technology envelope. The question to ask is, how can we make EMRs work for doctors. Until industry insiders understand this, Meaningful Use is Meaningless.

  • Brian hit the nail on the head. EMR’s should first and foremost be a cost effective tool to meet a clearly identified business need, with process efficiencies, and patient cost savings realized second.
    Today, the EMR solution is being pushed (forced) by the industry onto doctors as the cure for needs of the patients which seems like a backward approach, they are told they need to incur a huge additional cost to their practice to make it happen, huh?
    Seeing this, many doctors will employ a less costly EMR solution themselves, and as we’ve discussed in previous posts on this site, they soon discover once the leap to digital happened, there are many other supporting devices and technologies (which must be in place) but were not clearly explained or understood, added to what they thought or were told was a complete solution.
    They also soon discover a compliance aspect they have to meet, which the industry is still unsure how to completely resolve…Did “going digital” make the doctor’s job any easier? Many feel their troubles began when they made the turn, and see a huge pile of added debt, many more completely different issues than before, and the loss of a precious resource they could ill afford…Time!
    Technology is a hard sell especially to those who experience (or remember) its frustrations and failings, and haven’t realized its effectiveness in other areas of their life. People seem to forget how very new digital technology is in this industry, how fast it changes, its reoccurring costs, and the uncertainty of what will be required tomorrow. I can understand why many doctors feel it easier to continue with what they’re familiar with (paper). Many look out and see other practices around them having lost their basic focus of why they wanted to be a doctor in the first place…resolving medical issues and helping patients. If not applied carefully, technology can get in the way of what’s important!

  • Steve,
    We (eDoctor, Inc. offer free e-prescribing and data migration services so that doctors can “try out” EMRs. Obviously different vendors stipulate different sorts of agreements so it won’t necessarily be a “try every single one just like that,” plus you’d still have to cope with the task of training yourself and staff to be able to use the EMR (and these things tend to take a while to settle in), but the option is certainly there 🙂

  • Steve,
    The task of selecting and implementing an EMR is daunting. My EMR selection e-Book should hopefully help those that aren’t sure where to start. The idea of being a “target” of sales reps is interesting. I know a CPA firm that signs up for the EMR demos so their clients can avoid this.

    Charles Phelps,
    Nice points. The all at once approach is a dream. Even with a new office, you can implement most, but you’ll continually improve your use of the EMR. Maybe that’s a perspective that needs more addressing.

    The right IT person can make or break an EMR implementation for sure. Many of the “EMR Failures” I’ve heard about were IT support failures and not EMR vendor or EMR software failures.

    Leo Bletnitsky,
    Watch in 3 years we’re going to be talking about converting from legacy EMR and all the issues you talk about. It will become the most common topic and a whole cottage industry of EMR conversion companies will crop up.

    5 years is definitely just the start imho. Which is a good thing for my blog;-)

    Brian,
    I knew you’d love this topic. In fact, it’s what I found so interesting. A doctor’s daughter was so interested in her father using an EMR and he was still questioning the benefits. I’m not sure exactly why, but there’s a generational thing where the idea of doing it on paper versus using a technology is almost blasphemy.

    All of this said and to packets comments. The EMR vendors that will last long term are those that do focus on making EMR software that works for the doctors. The others will eventually wither on the vine and the doctors who use it will move to an EMR that provides those benefits.

    I think our difference in opinion is that you seem to argue that none of the EMR software out there works for EMR doctors. My opinion is that much of the EMR software out there doesn’t work for EMR doctors, but a number of EMR software does.

    I think one thing is clear. Interest in EMR has never been higher!

  • I’d like hearing BobbyG’s opinion …

    I think its first and foremost about having good processes. Implementing an EMR with different business rules than what your practice is currently employing is a prescription for a lot of frustration.

    A practice with good solid practices probably has a good idea of what it wants to focus on with its EMR and can narrow down the field to that package that does what they want … with the ability to grow with them in modules.

    A practice with circuitious procedures … isn’t going to get straightened out by an EMR. It will get tied in a knot.

    Get your processes straight first.

  • I am the lead developer and manager of a company creating a custom Oncology EMR. In my estimation, we have been very successful and it is because I keep a few concepts in mind every minute of every day:

    1. Champions – These are people who are excited to be involved in development and EMR implementation. Listen to them. Make them love your software by making your software so good they have no choice. These are the leaders of the practice and if they love your software, others will soon follow.

    2. Unwaivering enthusiasm – You must believe in your product and share your dream with others. Soon after, your enthusiasm will begin to wear off. Positive energy is infectious. Embrace mistakes and fix them.

    3. Listening – be positive, but LISTEN. Praise good ideas! Take them and run with them! Give people credit for proposing alternatives. Developers (and salespeople) are not users. Only by listening to users can we begin to approximate their experience.

    Our goal is to make our software so good that an interested colleague could talk to anyone in the practice and they will declare their love for our software. Adhering to the core principles above have helped us do that so far.

    Only by making software doctors (and nurses and admins) love will we ‘get Doctors to use EMR’

  • Nick,
    Some nice points and very important. I’ll just add that I’ll be interested to hear how you address these same topics as you start to scale to 100 and 1000’s and 10,000’s of users of your EMR. This is a much harder challenge to do what you describe with any scale.

    Although, I will say that I think your current strategy (at least as far as I understand it) is likely the one that will be able to scale this vision as much as any. The strategy to which I speak is your focus on one specific specialty: oncology.

    Many EMR software that I’ve seen started addressing one specialty group and did some amazing work. Then, little by little they wanted to expand their potential market and user base and so they try to serve more specialties. Seems like a good idea, until you consider your points above as you move to another specialty. The original specialty becomes slighted that you’re no longer focusing on them. The new specialty wonders why your EMR does things the way an oncologist would do it and not a pediatrician (or insert other specialty) would do it.

    Thus the risk you take of a tightly defined niche (which if you ruin you’re screwed) versus expanding to more niches.

  • Your point on EMR scale is well taken. Expanding a company and finding more employees/partners with the same values and enthusiasm is very hard.

    It WOULD be unfair to market an EMR designed for oncology to a cardiology office; we’re not going to do that.

    Our goal is not to engulf the entire medical software market with some over-grown, washed-out dishwater behemoth (too many of those already). Our goal is to create great software that will ‘get oncologists to use EMR’. If there are a thousand other small companies like us out there tending to specialty practices, I think the EMR usage will go up far more convincingly than with specialists squeezing their practice into software that isn’t actually designed for ANY discipline.

    It all goes back to “make software people want”. I think that’s really the fundamental answer to your question. (Thank Paul Graham for that one.)

    “Do what you do so well that they will want to see it again and bring their friends.”
    -Walt Disney

    http://brandautopsy.typepad.com/brandautopsy/2010/12/waltdisnet.html

  • Oh how I love Paul Graham.

    The problem is that EHR vendors that move beyond the niche are making software people in the new niche want. Sadly, many that are successful at the niche strategy will sale before it’s too terrible.

    Takes some really good intestinal fortitude to not do so. I know a few EMR companies that I think have that quality, but not most.

  • Hi Everyone,
    I have to say, it’s great to hear the variety in feedback and learning from the experience of others.

    I have been working in the EMR industry since 2007 and began my time working for the industry leader, eClinicalWorks. After working for the vendor for two years, I crossed over and began to work for the client-putting my experience to use for their benefit.
    I am grateful to be able to draw my opinions from both sides of the fence and here is what I have learned:

    You have to start at the beginning with a practice. Understanding their workflow, culture, fears and goals is the most preliminary step in a successful implementation.

    From this understanding, you then must employ the strategies best for the practice. As much as it’s my job to implement an EMR and help in its adoption, if they need six months to prepare for this phase, then that’s what they need. Giving them quantifiable steps to reach the level of preparedness they need, gives them a transitionary period and allows us time to focus on elementary preparation for undertaking such an arduous task.

    Next they need advocacy. It’s great, I agree, to see what’s out there for software offerings, but it also opens up the possibility for the practice to fall prey to great sales and marketing. All too often, the practice sees a demo, and is impressed-why? Because the salesman is demoing it. Once implemented will it truly satisfy the needs of the organization? It’s a gamble; I advise practices not to take. Aligning the goals, objectives and needs of the practice with the vendors’ offerings is key in ensuring the proper fit.

    Lastly, they need specialists, not only in IT, but all aspects of the process, such as: implementation, go live, workflow, policies and procedures and support to guide them through from start to finish, because once the trainers leave, the practice is on their own. Having the right person, with the right know how; always available, is key and aides in the comfort level of the practice during adoption. Knowing you’ll still be there tomorrow means you have a vested interest in the success of the practice.

    Switching from paper to digital is an enormous process. It’s a process we all specialize in and do on a day to day basis, which is why we all understand its complexity. Doctor’s practice medicine; that’s what they do.

    The key to success, in my opinion, is finding the level of balance to allow them to continue to practice medicine and focus on their patients, while collaboratively working with us to implement a solution augmented to fit their needs.

    http://www.ptsconsulting.com/documents/Articles/PTS-CON-AMMKT-Perspective-EHRImplementation-0002.2011-01-19.pdf

  • Nice description Stacey. Lots of good points made. Thanks for visiting the blog and I’ll hope you join in on the conversations often.

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