Some very interesting commentary from an EMRUpdate thread:
Six-plus years ago, I started my own office and my husband insisted on an EMR – mainly because the real estate prices were so high that he did not want to pay for file storage.
I have posted on this site over the years: early on, I was told I was crazy for picking an Application Service Provider (I think it’s now called “cloud computing”), and the site had a smartest-guy-in-the-room vibe.
But my EMR worked so I didn’t need help or a tech consult. So I went on my merry way and grew my practice – and downloaded quite a few babies, too! EMR was a big deal for me back in 2004; but now I never really think about it. Maybe the reason is that I was never searching for “THE PERFECT EMR” – I picke one that was “close enough” and made it work. EMR has just been a tool for me: I use it and I no longer think about it.
There are a lot of interesting parts about this EMR story. However, the one that struck me most is how now she doesn’t even think about her EMR software. Using the EMR is just completely natural for her.
Reminds me of when I talked to an old family friend who’s a doctor. I told him how I wrote a blog about EMR. After the initial pleasantries he described how he’d been using an EMR for so long (10+ years if I remember right) that he barely remembered what it was like to practice medicine without it. Needless to say, there’s no way he would practice medicine without an EMR.
Of course, for the other 50-75% of the world that doesn’t have an EMR, the question is how long will it take you to reach that level of comfort and what can you do to make your implementation reach that level as quickly as possible. Hopefully the lessons learned on this blog help many people achieve this goal.
There’s certainly a chicken and egg situation here.
10 years ago, EHRs weren’t great even for a savvy user, but at the least you could customize it to work for you and move on with seeing patients.
Now, you have user-friendly EHRs that even a non-savvy user can adopt, but so much of the residual frustration from the past has given EHRs a slightly negative vibe. HITECH is certainly fighting that by putting a very shiny carrot out there, but I still run across a lot of physicians who simply don’t want to change the way they practice.
That’s the crux of the issue. The “if it ain’t broke, don’t fix it” script is widely prevalent when it comes to practice workflow. You’re right that IT in general is just a tool that facilitates improved processes, but convincing some physicians to change their processes is a tough sell.
The government’s current adoption campaign is well-intended and will definitely increase EHR usage levels. Overall though, the trickle-down effect from EHRs will be managing PHRs, CCRs, HIE, and being open to alternatives in the way physicians interact with patients. That requires a much larger mental shift.
This shows the saying ‘practice makes the perfection’ but unless healthcare providers taste the sweet then only they will realise the goodness of it, instead of all driving forces.
Amen to all.
John, actually in your post on EMRandEHR, there was a guest article about the productivity loss during the implementation and guest writer alluded that loss should be expected!!!!!
Not really; if there is a phased approach to implementation, the patient volume does not have to go down nor does the operations suffer too much. Yes there is a learning curve and probably there is that extra 5 to 10 hours that’s required for the first 4 to 8 weeks.
As long as the Providers can slide into EHR, starting with documenting couple of patients a day and gradually increase to 100% of the patients over a 90 day period, there is no drastic loss of productivity.
Front Office (Scheduling and Patient In-Take) and Back Office (Billing and Claims) personnel are open to re-training and they get the advantages/try very hard to adapt.
Thanks for this article. Do your research; see which EHR suits the practice. Select the EHR and adapt to it; its a journey. Much more enhancements/features will evolve over time. No user is going to be using 100% of features on day 1.
Anthony,
Productivity loss during an EMR implementation should be expected. Certainly there are ways to minimize it as you suggest and a few people are able to generally avoid it, but most should expect some productivity loss during the implementation. Even if the productivity loss is just the time you take off to be trained on the EMR software. That’s still a productivity loss even if it’s just the bit of training.
I’d say that an extra 5-10 hours for the first 4 to 8 weeks with no decrease in patient load outside of training time would be great for most clinics.
The other point you make is a good one. How you design your implementation will drastically effect the productivity of your office during the EMR implementation.
“When EMR becomes natural…” is another way to say that the goal should be ADOPTION, not merely IMPLEMENTATION. This is the view that I, and others, have been evangelizing for some time. This is the EMR “Holy Grail”; whether your carrot is MU incentives, ROI, patient / clinician / staff satisfaction, or patient safety. To this end, I again recommend reading “BEYOND IMPLEMENTATION: A Prescription for Lasting Adoption
” by Heather Haugen, PhD and Jeffrey Woodside, MD. I can think of no better way to spend $16. The book explains to how to repeatedly measure KNOWLEDGE and CONFIDENCE to keep moving toward “When EMR becomes natural…”
The “phased” implementation mentioned above is terrific when it is managed very closely and works. Far too often, there are not concrete targets adhered to for incremental adoption – and it never happens.
Wes,
Thanks for the book recommendation. I added an Amazon link for people’s easy access to purchase it. I like the play on words between adoption versus implementation.
I agree that you have to be careful with a phased implementation. Although, my favorite story about phased implementations was one time when I did a phased implementation, about a month in the users started asking why we weren’t using the rest of the EMR software. We took that as our queue and stepped up the second phase and starting using the full EMR. So, it can be very beneficial in that regard too.
[…] to find an EMR or to complain about the EMR that they have. I guess part of it might be that the EMR has become natural and so they don’t likely think to learn or share their experience with […]