It’s Your Fault Doctors Don’t Like Hospital EMRs

Sure, some doctors are passionate EMR advocates. They know every nuance of how systems should work, speak passionately about the medical benefits EMRs can deliver, and adopt systems with the greatest ease.

The thing is, if I had to hazard a guess as to how many, those folks make up maybe 5 percent of the profession. The rest are suspicious and weary at best.

Many CIOs seem to see EMR-hostile as cowards or militants standing in the way of progress. But that’s an unfair and unproductive assumption. Lest we forget, let’s remind ourselves why many a sensible doctor might not be so thrilled by your EMR plans:

*  You made the final buying decision:  Sure, you may have given rank-and-file doctors a chance to play with various platforms, and perhaps a nice pep talk, but let’s be honest: the EMR that excites the C-suite players and board is the one doctors at your hospital must swallow.  Doctor feedback isn’t that important when top management egos are at stake.

* Your EMR may be a struggle to use:  I never fail to marvel at how many comments I see online slamming hospital EMRs, to the effect of “The new system is impossible to use,” or “They say it’s easy to make templates, but it seems almost impossible to me” or “When I needed technical support I just couldn’t get it.” Sure, training can help, but if your EMR is basically FUBARed from a usability standpoint,  you won’t be able to make things simple.

* Doctors may have to learn multiple EMR interfaces:  Doctors typically have admitting privileges at a few different hospitals, no?  And how likely is it that these hospitals use not only the same EMR, but the same interface and the same modules? Near impossible, I’d say. So doctors may go through three or four learning processes, fearing in each case that they’ll hurt a patient (or worse) if they get things wrong.

Hey, you have very important reasons to get your EMR into place, but if we’re totally honest, some of them have nothing to do with your medical staff.

Let’s not pretend that we’ve done everything we could to win doctors over, and got nothing but complaints in return. Doctors aren’t crybabies — they’re professionals who fear that you’re going to screw up their job.

If doctors ran the EMR adoption process, things would go a lot differently (something I’ll elaborate on in a future post.) Until that happens, if it ever does, let’s just hope that doctors are gracious enough to put up with the way you do business.

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.

5 Comments

  • Took the words out of my mouth. Not only are we worried you’ll screw up our complex workflow, but we’re offended that CIOs don’t seem to care. (And “we’ll just get Epic because everyone else is” is not a very reassuring response either–Epic’s success is purely a function of the dynamics of a pragmatic market.)

  • I can’t help but think that Brian was referencing the Technology Adoption Life Cycle when describing the pragmatic market that favors Epic.

    Currently, I am reading the revised (2002) edition of Crossing the Chasm: Marketing and Selling Disruptive Products to Mainstream Customers by Goeffrey A. Moore. Although slightly dated, it contains some very important insights that explain the difficulties we have with widespread adoption of EMRs and EHRs. He revises the Technology Adoption Life Cycle by placing a large gap between early adopters of technology and the early majority (pragmatic individuals/organizations), and cracks between the early majority and late majority (conservative individuals/organizations). The helpful insight is that, in each segment of the cycle, the expectations, demands, and willingness to be inconvenienced differs. Marketing must be different. Support must be different. Fulfillment of expectations must be different.

    I believe we all know innovators who have used some form of EMRs for at least two decades. These “techies” try and test anything, who love technology for technology’s sake alone. We also all know early adopters: visionaries who have high expectations for what the new technology can do. These expectations rarely match the current reality of the technology, but they enable the technology for as long as it appears the expectations can be realized. The goal of the visionary is to take a quantum leap forward.

    I believe we are now in the process of trying to sell this technology to the next cycle segment: pragmatisits – prudent individuals who do not want to be pioneers. They often have learned the hard way that the “leading edge” of technology is all too often the “bleeding edge.” The goal of the pragmatist is to make incremental, measurable, predictable progress. They plan on living with their decision personally for a long time to come. Pragmatists tend to communicate more with others like themselves in within their own industry. References and relationships are very important to these people and they won’t buy from you until you are established and can supply several references from within their network. Oh, by the way, they have an instinctive distrust of visionaries because visionaries 1) see themselves as smarter (lack respect for the value of colleagues’ experiences), 2) are focused on the future (bored with the mundane details of their own businesses), 3) fail to recognize the importance/value of existing infrastructure (e.g., the paper medical record), and 4) are disruptive (soak up all the resources for their pet projects).

    Pragmatists make up about one-third of the potential market, conservatives make up another third. Since we haven’t successfully “sold” pragmatists on the value of EHRs/EMRs, it’s not even time to consider marketing to conservatives. I suggest you read the book for a more in-depth description of all the cycle segments.

    I believe that much of the push towards adoption of electronic records is driven by visionaries, both in the industry and in government. I suspect that a large percentage of our elected officials could be described (or would describe themselves) as visionary. Occasionally we get appointed officials like Dr. Donald Berwick who are visionary as well and attempt, with varying degrees of success, to mold their organizations around that vision. The problem lies then in the fact that physicians are trained to be pragmatic and often act conservatively. And their is a chasm between the visionary early adopters and pragmatic early majority. The book suggests ways to cross that chasm. As someone who likes to think about culture change and vision, I hope we can and believe it is imperative we do.

  • I’ve only had the chance to observe doctor’s using EHR/EMR at one major hospital on Long Island, and mostly for outpatients. The doctor (a department head), walked around with a small laptop, plopped it down, and as she did the history and exam did exactly what you’d expect; check things off and pump in notes as needed. It did not slow her down in the slightest. And she was very clearly comfortable with it. Now I don’t know what she was using. Supposedly the hospital itself uses EPIC, but for outpatients might be using something different.

    A side thought; I never saw any noticeable billing errors on the EOB’s from these visits. Hmm.

    I also watched another doctor demo to me (during my appointment) his office EHR system. A true love hate relationship. He loved all the information including images, he hated the amazingly wasteful ‘flow’ including piles of completely inappropriate questions.

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