How EMR Process Issues Screwed Up One Small Practice

Here’s a story which I’m sure could be retold in practices around the U.S.  It’s a tale of how EMR process issues slowed down care to a crawl.

I recently visited small OB/GYN practice — a busy and seemingly prosperous one in a wealthy suburb — which had just implemented a popular EMR package. Knowing how small practices are struggling to make EMRs/EHRs work, I took a suspicious look around.

From the looks of things, everything was in place:  the EMR was available at every workstation used by clinicians and nurses, doctors had carts to roll their e-charts into exam rooms, and the use of paper was minimal.

Then, it was my turn to be seen, and the EMR (in theory) came into the picture. Whoops!  Things went downhill pretty fast.

First, I had my vitals taken by a medical assistant, all of which went onto a piece of paper.  Couldn’t she have had access to one of those carts?   Was the practice too cheap to buy enough terminals to make this not-so-cheap EMR a success? Process failure #1.

Then, I was moved along to a nurse to be asked some additional questions. Though the nurse seemed patient and careful, she had to ask me about my medications three times, because something about the system interface led her to dump the data over and over.  I’m not blaming the nurse (I blame the vendor and their UI) but that was definitely process issue #2.

Then, I finally had a talk with the doctor.  She didn’t make use of  the EMR at all!  She did look at some of the paper I turned in during my waiting room stay, and clearly listened carefully to my concerns, but didn’t take notes during the whole conversation, EMR or no.

I thought one of the great things about an EMR was to normalize how notes were taken and preserve the value of them from the point of care on.  Process issue #3 and the EMR is outta there!  (Well, I wanted to pitch it anyway.) Just how much clinical value could they be getting from this fractured way of doing things?

Folks, I have no idea how long the EMR had been in place there. This could have just been growing pains.  But my instinct is that more likely, the place is going to keep running its EMR in a hodgepodge style until it  begins losing clients or gets punished harshly for its inefficiency. Which do you think will happen first?

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • Yes I have seen this many of times as well. I am going to blame it on the The EMR Project Manager or if they even had one from the EMR Vendor. This is typical of most EMR companies of selling the product, doing little or minimal training without concentrating how to ASSIST IN incorporating the EMR with work flow processes to making it work for the practice.

    What you are seeing is meeting quotas, dropping the ball after the sale is completed, and horrible followup and follow through. Typical nowdays!

    You need to go in and offer your services of expertise and help in making things right! 🙂 Or email me and I can do it as well.

  • This is a common situation. I think that much of what you describe is a clinic that half heartedly implemented the EMR. They tried to ease themselves into the EMR by still using some paper in the process. Unfortunately, by doing so they’re actually making their lives more difficult.

    I wouldn’t say the doctor not using the EMR in the exam room is a terrible problem. In many cases, the doctor is able to provide the patient care without looking at the EMR in the exam room. I think that’s a viable approach. Although, they should have it somewhere closely available for the few cases where they do need to look. A lot of this depends on the specialty and the type of care being given.

  • My last doc visit had me scratching my head. At the lobby, no sign-in sheet. Great so far!

    Then they hand me a 4 page questionnaire, which I proceeded to fill out. When I went for the exam, the doc asked me some of the same questions from the questionnaire, and typed my responses into the computer. Which made me wonder about the purpose of those 4 pages. I doubt if anyone will ever look at them.

  • I know an orthopedic surgeon who bought an EMR for $25,000 but then didn’t have the time to waste in learning it, so they just use it for the scheduling calendar now. A $25,000 calendar!?

  • Dr. West, given what I’ve seen in both the literature and in my own care, your story doesn’t surprise me either.

    This actually points up a major flaw in the whole Meaningful Use incentive program for medical groups.

    While $44K isn’t chump change, I’d argue that for many practice, it’s far from enough to compensate for lost time, training, self-education and more.

  • That’s far from the only flaw. Although this also highlights why I believe doctors better focus far less on the EHR incentive money and far more on the benefits to their practice from using an EMR.

  • These stories are part of the reason why EMR have not been adopted. The work flow really needs to change to accomodate the electronic charting. Hybrid situation is often common. The reason is both the vendor and practice because both usually underestimate the changes needed to really get the system up and running well. Most practices do not slow down during an implementation and the poor doctor need to keep working at his/her rapid pace to keepup the volume.
    We studied the need for EHR in small practices for over 300 small physicians. Most do not feel that they benefit from an EMR. They really need a way to coordinate care with the other doctors they team with to care for their common patients as well as communicate with their patient. That is why a solution which has integrated EMR/HIE/PHR will likely be the solution that will get high adoption.

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