EMR Uptake By Doctors Slowed By Lack of Time And Knowledge, Not Just Cash

Hospitals, you probably know that small practices are the last ones to adopt an EMR, and you may find it pretty frustrating. You may also be assuming that the only reason most small practices haven’t brought an EMR on board is because they can’t afford it.

Think again, says Rosemarie Nelson, principal with the MGMA Health Care Consulting Group. In a new piece for KevinMD.com, Nelson argues that lack of time and knowledge is just as big of an issue, if not a bigger one, in small practice EMR adoption delays.

As she rightly notes, such doctors face a wide range of issues, including the following:

EMR selection:  Most small practice-doctors already have their hands full with patient care, and if they switch to working on EMR selection the practice loses money. So who does the vendor sorting, sifting and selection?

EMR expertise:  Choosing an EMR requires an understanding of the range of products available and how they might serve the practice, as well as a sense of how well vendors will support the product and the ability to handle the implementation. Whew! None of that comes easy.

Financial management expertise:  To get a sense of when the EMR has begun to offer a return on investment, the practice needs someone who can analyze current operational costs and productivity benchmarks, then compare those with projected operational costs and productivity during and post go-live. That’s another tall order.

Staffing the EMR implementation:  Few small practices have the human resources readily available to implement and manage an EMR. Certainly, existing clinicians already have their hands full.  Nelson estimates that the implementation calls for a full-timer for three to six months, plus .20 to .25 of an FTE for ongoing support and management. Where will those resources come from?

Ultimately, practices typically end up seeking help from outside consultants who know the EMR playing field, but even that’s a big and costly decision which calls for its own selection process.  No matter how you slice it, it’s hard to argue that small practices are still up against it when it comes to EMR adoption. So maybe it’s time for hospitals to step up on the management support front, no?

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.


  • Add fear and loathing! 🙂 All kidding aside, there is tremendous fear of EHR adoption for all the obvious and the stated reasons. But also, doctors have heard from friends or seen for themselves plenty of botched adoptions or bad systems. One doctor I know works part time in a hospital, part time in her own practice. She despises the EHR in the hospital; it costs her many extra hours of work. She won’t even consider one for her practice (she has minimal CMS exposure).

  • In addition to these aforementioned issues that face small practices, most EHRs are not designed to adapt to the way these providers ACTUALLY work and fail to consider the natural provider workflow in a small practice setting. As such, they can add a layer of technological complexity that replaces a labor-intensive, inefficient paper-based processes with an almost equally challenging electronic system…all very far from the goals of #MU.

    So quick EMR vendor selection tip: look for a vendor that considers the natural provider workflow, one that is based on work with providers, not just fancy engineering. For more on the importance of natural provider workflow and EMR adoption in small practices, check out this blog post on “A Closer Look at EHR Adoption:” http://bit.ly/RoWdc7.

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