Listen to the Local Tribal Medicine of a Practice During an EMR Implementation

At the recent Health Tech Next Generation conference that I attended, I heard someone refer to the “local tribal medicine” practices that are found in a practice.

I found the description incredibly intriguing and descriptive. It’s an incredibly apt description of many of the practices and norms that exist in a medical practice. Each practice has created what becomes an almost tribal mentality when it comes to people’s passion for existing workflows and processes. [It’s worth clarifying that it’s tribal as far as people’s passion for doing the workflow. Not because the practices and workflows themselves are tribal.]

I guess this is a natural thing that happens not only in medical practices, but throughout life. We grow accustom to certain processes and practices and so they start to feel really comfortable. Changing them can throw people for a loop even if you exhibit incredible care in the process.

I was recently asked by a reader whether I thought it was better for EHR vendors to look at changing the current operations to match the EHR workflow or whether it was better for EHR vendors to adapt to the current clinic workflow. Here was my response:

It’s an interesting dynamic. Part of it depends on the type of clinic that you’re dealing with. Sometimes a clinic has such terrible workflows that they need to be fixed before you apply an EMR. Otherwise, it will exacerbate the clinical workflow problems and cause some real pain.

However, I generally think it’s best to try and mimic the current process as much as possible when first implementing an EMR. Point being that you should cause as little disruption as possible. Although, it’s best when there’s some flexibility with this approach. Some things are possible in the electronic world that weren’t possible in the paper world and so there’s no reason to delay implementing those benefits when they’re pretty obvious.

Then, I suggest taking a look at the EHR system and how it’s working about a month (sometimes even a bit sooner) after implementation. At this point the clinic is proficient enough to talk about all the EMR features they were too overwhelmed to implement at the beginning.

Then, 9 months to a year out you can do another review to see what processes would be more efficient or could leverage technology better than you’re doing already. I’ve found that this review is when doctors really start to love their EHR and really start to see the value of using an EHR in their clinic.

In summary, I agree with modeling the current clinical workflow as much as possible to start, unless the practice is a mess. Then, I suggest evaluating those clinical workflows after the clinic has experience using it.

I’d love to hear your thoughts. How do you deal with the local tribal workflow of a practice? Do you want to change them during the EHR implementation or wait to make the changes?

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.


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