Many of you might remember my recent post about EMR Performance Issues (ie. EMR Slowness). Turns out, the post had a pretty big impact on some readers of the site. In fact, it sounds like it was partially therapeutic for some to realize that they’re not alone.
I asked permission to share one of the responses with you so you could get some more first hand perspective on the issue of EMR slowness. I share it in the hopes that others can be aware and avoid it. Plus, I hope the EHR vendors that read this will take it to heart and be fanatically focused on EMR speed and customer support.
I’ve removed the name of the writer and the names of the vendors. Plus, realize that it was written originally in an email communication and not necessarily to be published.
OMG…you hit the nail on the head with this post. Our EMR is so slow. It often takes minutes between pages. My clinical and front office staffs so frustrated. We have had nothing but finger pointing going on ever since.
Part of the issue is the interface between our practice management system VENDOR A and our EMR VENDOR B It takes a minimum of 3-4 minutes for data entered into VENDOR A to roll into VENDOR B. My front office staff has taken to entering the data twice, once in each program in order to get our patients registered timely. When you see 80-100 patients in a day, a few minutes makes all the difference.
Additionally, certain criteria does not roll over, namely email addresses. This makes it impossible for us to send out patient visit summaries thus we are unable to meet meaningful use for that criteria. Referring physician is another part that does not roll over.
The most frustrating part is that no one will take any responsibility for the issue much less work on fixing it. These two vendors spend all day playing the blame game. Fortunately for our practice, we have a wonderful IT company that we work with. Our IT specialist has spend countless hours trying to mediate between these two vendors. Most times he just fixes what he can but we are paying for his services in addition to the tech support agreement with VENDOR A and VENDOR B.
A perfect example happened this week when the EMR went down in one of our exam rooms.. First we spend at least 10-20 minutes on hold waiting for a VENDOR B tech to pick up the call. In this particular case, they worked remotely for at least 4 hours on this one computer only to tell us they could not fix it.
I called my IT guy and he fixed it within 10 minutes. My staff spends countless hours on the phone most days trying to keep the system up and running. We are in the process of replacing all our PCs and I recently upgraded our Internet to a 10×10 fiber service however we still are not seeing any difference in speed.
It is at least comforting to know we are not alone. I plan to hang up your post for all my staff to see. It may not make our system work faster but hopefully it will give them some comfort knowing they are not alone.
Thanks for all the great information.
I wonder if either or both EHR and PM are web or cloud-based as the doctor mentions upgrading their “Internet to a 10×10 fiber service” and expecting better performance that unfortunately they do not perceive. I also wonder how much the upgrade cost initially and their monthly internet fees.
All interfaces are not created equal. This is not to say that some interfaces cannot be excellent, but it is to say that assumptions of data exchanged and interface performance should be verified. Products that are sold as a single product are all too often actually an EHR connected to a PM that was acquired. There can very well be redundant data entry required even in that scenario.
The lack of accountability between the two vendors is not unusual in the IT world, though that doesn’t make it less frustrating.
If these two products were sold together, there should have been a contract provision designating one as the technical lead. Without that, no one is responsible for the full system.
In addition, I can’t tell how these aps are hosted. Art they together? are they in the cloud? Finally, are they alone or is this typical of this install?
Regardless of the architecture for the EPM and EHR (if it’s hosted locally or remotely) software companies and vendors are always going to point fingers if they’re unsure of the problem. It’s just life.
What I see as a problem is the practice is having to decide who’s problem it is, and then eventually getting frustrated and calling the IT company.
Software functionality in larger corporate environments always falls under the umbrella of the IT department – this allows them to be the advocate for the entire company.
Now, when you get to the scale of a normal practice, they usually have to be cost conscious about IT expenditures and have an outsourced IT company contracted. They’ve already made a big investment in practice software, so they are usually up to their eyeballs in technology costs. But, if smaller practices just go that extra mile and have their outsourced IT company handle the vendor management on their behalf, things can work out much better.
Who’s time is worth more? Your practice admins or your IT company’s? If you don’t have your practice admin making calls to your EHR / PM vendor, your IT vendor can be doing that on the practices behalf. Generally speaking IT guys know what to say to make other vendors work with them – even if it’s a hosted environment. Sometimes, the only way to move forward is to select another software vendor, but at least you have an advocate for the practice that is working while your staff can be delivering patient care.
Just my $.02
This illustrates the value of having EMR + PM from the same vendor. One phone call to make…one entity responsible for tech support.
Mark,
Not sure if they’re cloud based or not, but upgrading your internet to improve speed on an in house server would be a mistake in most cases. Although, since they’re interfaced, it really makes me wonder. I’ll have to go back and ask or check the vendors to see.
Carl,
Good advice.
Michael,
I agree that the IT person should and could be held responsible. The challenge I see with that approach is two fold. First, a lot of IT guys aren’t very good at that type of “negotiation” with vendors. Sad, but true. Second, many doctors have a hard time finding a competent IT person to help them.
Charles,
This story definitely supports this argument. Also explains why long time EMR only vendors like SOAPware built their own PMS. They wouldn’t have done so if these problems weren’t an ongoing issue.
[…] 3. Infrastructure is key to performance – I love when people say “My EMR is Slow” cause it’s such a general statement that could have so many possible meanings. Regardless of the cause of slowness, the EMR is going to get the blame. For those wanting to dig in to the EMR slowness issue, you can read my pretty comprehensive post about causes of EMR slowness. I think you’ll also enjoy some of the responses to that EMR slowness post. […]
If you were to design the fastest possible EHR what considerations would you make?
1) Remove Latency – This means that the Internet and the LAN have to go, they take WAY too long. Disk latency is still slow compared to RAM but we can live with that. Dump your SaaS solution, it will only perform as fast as your slowest link in the chain. Instead buy a solution that works on a single PC with no dependency upon the WAN/LAN.
2) Choose a FAST software foundation – Microsoft Excel works well, type in a number, see result. No delays. Works well on millions of PC’s all over the world, in every language, every day in every business imaginable.
3) Eliminate massive data searches – Don’t search through thousands of CPT codes when you only really use about 200, don’t search though tens to hundreds of thousands of Dx and Rx codes when you only use a tiny fraction of what’s out there. Cull your lists to just those items you actually use.
4) Where possible make it a point and click – This mechanical operation takes 1/10 of one second to perform, the cognitive selection process differs greatly by physician. Macro’s help here big time.
5) Delegate – Where it’s legal to have staff perform the labor, do it! The Physician/Provider is always the bottle neck, make sure he/she does as little work as possible on the EHR (Administrivia). No work at all is actually perfect but we all know Drug Interactions, HPI and PE need to be performed by the provider.
Providers who master these 5 rules enjoy 4 day weekends and make twice the money of their peers.