Hospital EMR Crashes And Burns Because Community Docs Hate It

While we may argue over the stats — is it 30 percent, 40 percent, even 50 percent? — everyone knows that the failure rates for hospital EMR installations are frighteningly high. So it never hurts to look at specific cases and see if we can avoid that particular train wreck.

So here you have it. Courtesy of medical informaticist Brian Martin, we have a compelling tale of a $50 million EMR installation that went belly-up largely because the hospital didn’t “get” the needs of its 1100+ community-based physicians.  That’s $100,000 per bed, or if you prefer, $50,000 per staff physician, he notes. Ouch.

Since Martin tells the tale so well, I’ll turn the story over to him:

I did a post-implementation technology audit for the board of directors of a 500+ bed hospital with 1100+ physicians on staff. The hospital had spent over $50 million acquiring and deploying the then Alltell/Eclipsys EMR/CPOE system, which at that time ran on an IBM ES/9000 mainframe.

Soon after implementation, BoD members fielded numerous complaints from staff physicians who refused to use the system because of its perceived lack of usability…

Fast forward a few years; the BoD approved a significant expenditure to replace the EMR/CPOE system with Epic…Note that the Eclipsys system was based on a very successful implementation of the original Lockheed/Technicon Data Systems CPOE in use at the NIH Clinical Center, so we were dealing with field-tested and validated software that had seen successful clinical implementations.

The implementation failure had more to do with not understanding the technological needs and expectations of community-based independent physicians who comprised the hospital’s staff physicians, and therefore not incorporating their needs and expectations into the technology selection process.

<clap clap clap> What a great overview! Much to think about there. It’s definitely a reminder that even the best EMR technology isn’t worth much if users balk. (Why we’d need that reminder at this point, I can’t imagine, but hospitals still steamroll EMRs over unwilling docs regularly.)

I’d like to think that this kind of fiasco is largely a thing of the past. With Meaningful Use forcing hospitals and doctors to work together more closely, one would hope that boards of directors would build acceptance before they spend, if for no other reason than they’ll get walloped later if they don’t.

But hospital leaders are still among the most conservative creatures on earth, and the kind of top-down style we see in action here isn’t going anywhere soon. Oh well — what’s a $50M mistake among friends?

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

  • You talk to doctors who work in hospitals; how many of them like the EMR? And is there a viable EMR in the ER, and does it properly integrate with the rest of the hospital? Does the doctor in ER make entries as he examines the patient, and kick off lab tests and pharma orders on the spot? Can he order admissions that don’t require numerous phone calls and faxes? Does it take more – or less, time, for a doctor at the bedside to make all entries into the EMR? Do the entered data and notes help at later visits, or subsequent admissions?

    Or as one doc told me, they didn’t ask her opinion or even what she needed, they didn’t sit with her to check out her workflow, they gave only minimal training before and little or no support after go-live! And she hates the system; it adds hours to her daily schedule, and she still uses paper during rounds and puts it into the EMR after her scheduled hours – the only way she can get rounds done on time.

    Or as another doc told me, he keeps having to switch from page to page as he does an exam, since different parts of the exam are not grouped properly. And it makes him click on piles of stuff that doesn’t have anything to do with his specialty, and asks piles of absurd questions.

    As long as hospitals and even large practices take a top down approach, with little interest in the needs and thoughts of the users, there will continue to be piles of failures – most of which could be avoided.

  • I was reminded recently of some additional issues that can lead to failure. First – do one or more departments already have an EMR – and what do they like or dislike about it? Can theirs be integrated or does it need to be replaced? And do we really know who does what, and how, and when in the various departments of the hospital?

    It helps to remember that putting in an EMR is a PROJECT – and full project management methodology needs to be used. And that starts with a very full understanding of what you are trying to do, and why, and absolutely needs the buy in (and participation) of the bulk of those affected. If you skip steps – especially early on, you will fail.

  • Great comments above, I have spent years in hospital consulting and still am amazed that the C Suite does not get the message that for implementation to become utilization they first have to know the skill set and workflow of their staff.

    Know how the end user will actually use it (workflow processes and time frames spent) what do they need, not what will the system do.

    What the system will do is a vendor value based pushed at you sales pitch, what you need it to do is your infrastructural clerical / clinical and systems goals.

    Also the various points of patient F2F encounters, how many times are things being re-keyed because the EMR is still a silo and is not an interoperable answer across the provider’s entire system (ED, ADT/REG, LIS, Pharmacy, etc.)

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