Breaking up with Your EMR is Hard to Do

In light of this week’s “holiday,” I thought I’d take a look at the current love/hate relationship the healthcare industry seems to have with electronic medical records and Meaningful Use.


Thanks are due to @mdrache and @EHRworkflow for their inspiration for the title of this week’s post: EMRtweet1


The nay sayers seem to have become especially vocal lately, which may be due in large part to the passing of time. Those that have implementations under their belt now feel qualified to talk about the efficacy of the solutions they selected. Negative EMR press may also have bubbled up to the service in light of the recent RAND report, which backpedaled on previous predictions of cost-savings associated with healthcare IT adoption. That study broke the ice, so to speak, and perhaps made providers more comfortable with voicing their discontent.

In any case, if current healthcare IT press is any indication, EMR technology currently on the market has often left providers dissatisfied for a number of reasons. No doubt this dissatisfaction will be a subject of many show-floor conversations at HIMSS in a few weeks. I wonder how EMR vendors are preparing their responses. What will be their top three talking points when it comes to EMR benefits? It seems Meaningful Use incentives have lost their luster, and in fact have left many providers disenchanted with healthcare IT in general.

John Lynn posted a very telling reader comment over at from a provider who used his Meaningful Use malaise to create a new independent practice business model. Is this an indication that more providers may “revolt” against Meaningful Use and the trend towards hospital employment? If so, what will the private practice landscape look like in three to five years?

Just how easy is it for providers to truly “break up” with their EMRs? We’ve all read the multi-million-dollar rip-and-replace horror stories – talk about a bad breakup. And then there are the providers that stay in dysfunctional relationships with their EMRs because they can’t afford a new one, instead developing copious amounts of workarounds potentially at the expense of clinical care and accurate reimbursement.

As of last summer, KLAS reported that a whopping 50% of providers were looking to replace their ambulatory EMRs, compared to 30% in 2011. A recent Health Data Management webinar noted more than 30% of ALL new EMR purchases are made to replace an existing EMR.

To me, these numbers beg a number of questions. Were first- and perhaps even second-generation EMRs just not mature enough for providers’ needs? Did providers simply not do enough due diligence before making their purchases? Will these impending replacement EMR purchases stick? If you have updated EMR breakup statistics or a crystal ball, please send them my way.

About the author

Jennifer Dennard

Jennifer Dennard

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.


  • One aspect ths article touched on was the cost savings of associated with an Investment in an EMR that the RAND report referenced and back pedaled from. The reality is that for most an investment in an EMR has increased the cost of doing business for healthcare professionals.
    There are many reasons for this, from poor IT support to lack of alignment strategies to poor selection process due to thinking one size fits all. The cost of ownership has been widely mis calculated by the industry and the healthcare professionals are stuck with the bill.

  • Thanks for your comment Scott. How do you think the miscalculated cost of doing business with an EMR compares to doing business without one? I assume it differs from practice to practice, but I’d be interested to compare the two.

  • 1st generation EMR buyers did not know enough to know what they didnt know.Its difficult to improve upon something you’ve never heard of before. Canned demos painted a rosy glow- panoramic and magical, as if you plugged it to a server, and got ready to be amazed. Sadly, providers found they needed to create templates, short lists,favorites. Upcoding wasnt legal, or even possible as portrayed. So the 99212 never became the 99215. Revenue wasnt pouring in but pouring out bc of late night and weekend documentation, decreased patient volume and critical errors in claims. The magic wand was broken. Specialists were left in the cold. 1st gen. EMR’s were designed to work for FP and IM (With IM being a stretch). Everything else was “customizable”. We learn a lot from using something for awhile. We learn implementations need to last longer than 3 days on site. Training is not 2-5 days, and the “ramp up period” is a lot longer than 90 days. Impending EMR purchases are smarter, because EMR’s are smarter. Its the progress of technology. We now conduct role based demos in person, test drive, hire consultants, and make informed decisions. EMR vendors learned the hard way too. Many arent even around today for 2nd gen. You cant re-wire physicians. Technology only works when you align it to existing clinical work flow and process. We had to go through a rip and replace to learn the tough lessons. Either it works for the physician today or it doesnt work at all. Our lusty love affair with the magic EMR is over. It was replaced with a much more “mature” relationship, with usability.

  • Sadly, sometimes breaking up is accompanied by anger and recrimination. I don’t think the well-intentioned designers of Meaningful Use fully appreciate the growing fury among physician EHR users. As Linda points out, next-generation EHRs are better (more usable due to workflow & language tech, mobile/cloud deployment & access, etc.). But will they have a second chance?

    Social media is a great way to find birds-of-a-feature, so we can flock together tweeting about common interests. But as advocates of healthcare social media, who believe it is a force for good, we have a responsibility to listen to not just those we are similar to, who we agree with, but also other voices as well.

    I tweeted some examples this morning (not sure will work in a comment…):

    “…promise of EMRs is failing… to accomodate #MeaningfulUse the screens & clicks seem endless” #EHRbacklash… @medrants— Charles Webster, MD (@EHRworkflow) February 18, 2013

    “A great, great opportunity has been missed & we are saddled w/antique tech” #EHRbacklash #MeaningfulUse… @medrants— Charles Webster, MD (@EHRworkflow) February 18, 2013

    “‘Federal officials are drafting new rules to address concerns about the current systems.’ AAARRRRGGGHHHHHH!!!!!!!”…— Charles Webster, MD (@EHRworkflow) February 18, 2013

    Last year, physician users who criticized currently available EHRs were ignored as crackpots or dismissed as Luddites. Since then they’ve multiplied and become both more nuanced and more critical of their EHRs and the programs they blame. Consequently, they are harder to write off.

    I routinely search Twitter for tweets mentioning workflow, usability, clicking, meaningful use, etc. Some poignant tweets occur late at night and in the very early morning. Physicians are literally swearing at EHRs. And tweeting it.

    If we don’t do something, the EHR will be thrown about with the romantically scented, rose petal strewn, bathwater, so to speak.

    So as to not end on too down a note (but still in keeping with the analogy), here’s a tweet I wish I though of on Valentines Day.

    Today’s Thought™®© Roses are red/Violets are blue/EHRs ____/Docs ____! (fill in blanks & RT)… #TooLateForValentinesDay— Charles Webster, MD (@EHRworkflow) February 18, 2013

  • What a wonderful post and comment thread, Jennifer, et al! Not because of all the problems that providers are having with EHRs (about which they are now bemoaning ever more loudly), but because it is crystalizing the much needed commentary about the state of the HIT industry. I’ve long said that virtually every EHR/EMR I’ve ever seen has been sold with “we’ll even butter your bread and wash your windows” hyperbole. Most all promise far more than they ever deliver (with very few exceptions.) I firmly believe that HIT is essential for improved patient care delivery, regardless on HITECH/Meaningful Use, but there’s a broad patch of ocean to navigate before most EHRs can be called helpful. The vast majority are more a drain on the healthcare system – both ergonomically and financially – than they are a helpmate to providers or patients.

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