User Resistance to EMRs After First Technical “Issue”

In many health IT publications, hospital staffers and clinicians have been painted as Luddites who instinctively hate technology. In this version of the EMR story, recalcitrant users are the reason for every hitch in the adoption process, and certainly a big factor when rollouts don’t work.

The truth is, however, that sometimes hospital users have good reason to dislike their EMR. In particular, they have every reason to be concerned, dismayed and just plain PO’d when they can’t get technical support in times of need.

The next challenge in getting hospital workers and clinicians to adopt EMRs is offering them some form of technical support, or  reasonable workarounds, available 24/7.  After all, hospital care runs every day around the clock, and it can’t stop because some template is misbehaving.

Hospital workers don’t have time to fiddle with an application if it doesn’t fit their needs or seems to be backfiring. And if they lack technical support and good tools, they’ll resort to workarounds that shouldn’t ever be used. (Consider the case of the nurse who wrote data on her hand to carry it to her EMR station.)

Sure, staffers may tolerate problems with new devices or applications once or twice.  They’re professionals with good educations, and despite what you hear in the press, will make an attempt to keep working.

But if they face problems that slow their work down, and don’t have an immediately-available resource for handling issues quickly, things can get ugly. Some will refuse to use EMRs or related technology, others will develop bad habits, and some will just engage in passive resistance tactics which undermine the value of your EMR investment.

What can hospital IT departments do to avoid this quagmire? Well, it seems to me that the following might be a start:

Create a knowledge base:  Your hospital may already have super-users in place to help their colleagues get through EMR problems. That’s all well and good, but if they’re working one to one, their efforts stop right there. It might improve their value to have these experts — as well as other users who have solved problems — enter at least some of their solutions online and make the content searchable.

Offer videos teaching solutions to common problems:  At Texas Health Resources, the health system has posted videos on a dedicated page covering key topics in using their EMR, as well as backgrounders and case studies which help to build user confidence in the system.  In my experience, this approach could be used far more often.

Contract with an outside support organization:  To be candid, I don’t know whether this is a cost-effective solution, but it might be worth finding out whether it’d work best to offer 24/7 support via an outside support organization. (Personally, I’d be afraid to contract with the vendor itself, as I’ve never heard of one that offers top-drawer support.)  It’s particularly likely that contracting out is possible if  you’re running a popular platform like Epic or Cerner.

Establish a regularly-updated solutions site:  This approach, a relative to the knowledge-base, consists of a dedicated mini-site upon which the IT department can post updates on problems they’ve encountered and workarounds that they recommend. Creating a single site, and promoting it occasionally via e-mail, beats the heck out of sending patch updates and geeky discussions of upgrades to ordinary users.

If your hospital uses a blend of these techniques, I submit, users are far less likely to be frustrated and do what they can to avoid EMR use.  But these are just proposals. If you can share techniques you’ve used to offer round the clock support, we’d love to hear from you!

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.


  • Where in this list is abandon your outdated products on 138MB RAM PCs and get somebody who knows what they’re doing to build something that remotely reflects our extremely complex and unpredictable workflow?

  • Brian,
    Were you typing that comment on one of those 128MB RAM PCs and it couldn’t keep up with your typing speed?

    You’re so right though. It amazes me what some places continue to put up with. I can’t imagine being an IT guy for those companies. Particularly cause there’s a pretty clear financial case for regular replacement of PCs.

  • Brian,

    One option would be to deploy the EMR (if it is a premise based solution) via Citrix and convert the existing computers to intelligent, managed thin clients.

    At the time i am writing this, you have at least two good options to do so. My favorite is iGEL Universal Desktop Converter. Mainly because it allows you to deploy windows based thin clients, linux based thin clients and convert existing PC’s to linux based thin clients while managing them all from a single pane of glass.
    Other options include DevonIT VDI blaster.

    both of these solutions support almost all the flavors of VDI as well as traditional clients such as Xenapp and Terminal Services.

    Wyse even got into the game with Project Borg, however the purchase requires that you commit to purchase a thin client when you convert a PC. something i passed on with my last project.

    the great news with these initiatives is you can skip upgrading the hardware (ok maybe 256mb would run better, but not really.)

    hope that helps.

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