Small Practices Don’t Really Have Someone To Trust When Adopting EMRs

If I were running a medical practice — and knew I had to roll an EMR soon — I’d be banging my head against a wall.  While there’s plenty of talk about the reasons for EMR adoption (in some cases, 44,000 reasons) what consistent, reliable, accessible sources of information can physicians find on the subject?

You may think, “doubtless there’s plenty of colleagues to talk with, not to mention news stories and how-to sites out there, for physicians wanting an EMR,”  but it’s really not that simple:

*  Sure, physicians trust their peers, but with so few having gone whole-heartedly into the EMR game, there’s not a ton of peer support available — and that holds adoption down. You gotta love the whole chicken-and-egg dilemma here.

* Medical practice journals toss off the occasional article on the subject, but they’re often just highlighting a study on how many their peers are also looking into buying in (big help!)

*  Consultants of unknown bias pump out advice on how to choose an EMR, but it’s scattershot and often goes too technical or gets long-winded

*  Bibles of the medical news industry may pop out a case study or two on EMR adoption, but they’re usually focused on big players like the Cleveland Clinic, not the two- to five-physician practices that really need feedback.

* Sure, there’s the Regional Extension Centers, but I’m having trouble visualizing how an already intimidated doctor would bring him or herself to spend enough time with them to benefit.

* Of course, vendors are happy to tell nice stories about EMR use by small practices, but everyone takes those with a grain of salt, with good reason.

In other words, for a problem of such importance, there’s far too little appropriate guidance out there.

In truth, some medical societies probably are reaching out, not to mention hospitals, health plans and government, with reasonably useful suggestions.  But it’s still like a violent info thunderstorm out there.  Unless physicians find an ongoing source of reassuring guidance, which seems relatively unbiased and thorough, many are likely to hang back.

It comes down to this.  Incentives or no, no small business in or outside of medicine makes such a significant purchase without feeling comfortable — and if I was a low-tech doctor, I wouldn’t know how to get there. This can’t be good.

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.


  • “Sure, there’s the Regional Extension Centers, but I’m having trouble visualizing how an already intimidated doctor would bring him or herself to spend enough time with them to benefit.”

    If there’s one word I don’t associate with the word “doctor,” it’s “intimidated.”

    Irascibly dubious, perhaps (and not without reason).

    Moreover — and I can only speak for my own REC — there’s a distribution of willingness to spend time with us, ranging from the cursory to the desire to use us as unpaid on-call adjunct staff. Some of our docs are “high maintenance,” others are able to pretty much willing and able to take majority ownership of getting HIT done.

  • John,

    I think in many cases the vendor’s resources end up filling this void. This can be a good or a bad thing depending on the talent, experience, and availability of the vendor’s implementation/training team. A great or not so great trainer can really make or break a successful implementation, for even the “best” products.

  • Bobby, I agree that doctors aren’t easily intimidated by anything related to their field (or on the highway LOL) but I still hold strongly that there’s not a technophobic streak in the profession. YMMV, though, of course. All I know is that the very primary care practice I use, which is staffed by people 10 years younger than me, hasn’t even given its staff e-mail!

    Steve, I’m not knocking the good stuff vendors turn out — I’ve seen some training materials freely available which were quite impressive, in fact. But the reality is, if I were a potential buyer I’d any such material suspect, particularly if I didn’t know enough to know if they were snowing me. My feeling (though of course, coming from being in b2b publishing forever makes me prejudiced) is that if I were a vendor I’d sponsor courses published by a neutral third party. What do you think?


  • Katherine, that’s not a bad idea – having courses published by a third party; when you find one – please let me know!!!!!!!!!!

    John, I believe that the ‘complexities’ are blown out of proportion. As long as there is a willingness to embrace EHR, the process of implementation and adaptation is efficient. Not easy but can efficiently be executed.

    My personal experience with one of the practices in NJ; had no computers at all. Most of te Staff of 5, including Office Manager, did not have any previous experience with web or computer key board. All schedulings were done on paper and the ‘Super Bill’ faxed to the biller. 6 months back when one of our advisor suggested that we take this client on, we were apprehensive.

    After 6 months, to-day, they are scheduling the patients using EHR, capturing history, vitals, etc., in the EHR and Super Bill is also created in the EHR from where the biller takes over. Doc is yet to start using the EHR for capturing medical/health information; she has scheduled to taking training couple of hours a week for the next month. And I am sure she will get there.

    There was no disruptions in service or cash flows. 95% of the training was remote and support is remote with ‘go-to-assist’. Yes, the Provider is yet to get on the system; she is 60+ but has shown the resilience to get on to the system…………..

    I believe there is enough support (genuine!!!!!!! support) from vendors; and although it may be biased or perceived to be biased, its support nevertheless.

    From the trenches, we see that EHR is accepted as mainstream, especially the ones which are seamless and comprehensive from Scheduling all the way to billing/claims and Financial Management/Reporting tools. The early adapters are now working on PHR and deciding on what needs to be transparent and how to leverage PHR/Social Media, etc., to market the Practice/Business Unit to consumers.

  • Might be a good idea those neutral third party courses funded by the vendors …

    … though with regulations that don’t let pharma reps leave cup holders or pencils at the PCP seems like a bit of a gap getting the idea by the Feds.

  • THIS IS HUGE – WE AGREE 100%. EVERYONE WANTS SOMETHING AND IT MAKES IT HARD TO TRUST ANYONE! Quite frankly, is the only company that has had a great reputation of doing what’s right for physician practices! Great article.

  • PatrickSF techcrunchemr
    As an independent IT Consultant who supports several medical practices and has had some dealings with Practice Fusion, I must say that PF is an overly simplistic and disappointing product. At first I was excited about the possibilty of a free EMR product, but I was soon forced to drop PF as an EMR option for several reasons.PF completely lacks or is extremely weak in the areas of workflow & status tracking, reporting, billing and data access. furthermore, PF lacks the ability of in-house lab results entry. PF lacks a user accessible or editable table for lab results. True, PF does offer integration with numerous third party lab companies, but that is only of secondary interest for most of my clinical clients. A few of my clinical clients do almost all of their labs in house. So, the lack of a user accessible & editable lab results table renders PF completely unusable. I, and many others have repeatedly requested the addition this functionality, but all have received the same, standard PF smug snub.

    While the oft repeated comment “You get what you pay for” is certainly valid in the case of PF, I honestly have to question the basic validity and intent of the ONC’s certification program for EMR’s. I have yet to discover any EMR/EHR solution that actually aids and improves the practice of Clinical Medicine, but how such a primitive and simplistic product like PF could possibly be considered certified by the ONC for Meaningful Use simply devalues the whole concept of Meaningful Use. I guess the ONC’s concept of Meaningful Use has less to do with the improvement of Clinical Medicine than it does with appeasing big money lab companies, advertisers and EMR/EHR vendors. It certainly isn’t benefiting Clinical Medicine.

    The overriding premise is that EMR vendors and sales persons are interested not primarily, but only in money. I am aware of several examples of physicians being completely taken advantage of by dubious vendors and their third party intermediaries. In one such case the intermediary was a Medisoft “VAR,” an acronym (and product) that I have learned to despise. The acronym VAR stands for Value Added Reseller, but I’ve found that generally not to be the case. The VAR’s, like the actual software vendor are interested solely in money. Also, the VAR’s lack the ability to make any substantial improvements to the software. It’s a system concocted by vendors who don’t want to entangle themselves with actual users and their questions, needs or criticisms. So, be very careful about EMR products marketed & sold through third party “VAR’s.” That is a recipe for disaster.

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