Doctor Explains Why He’s Avoiding EMR

Dr. Peter Kambelos likes being in solo practice because he can make all the decisions.

And for now, the internist has decided to keep using paper records.


It’s partially an economic decision. He doesn’t feel he can afford the switch to an EMR.

Politics might play a bit of a role, too. Kambelos, who is president-elect of the Academy of Medicine of Cincinnati, likes to keep the government out of his exam room.

Still, he doesn’t rule out going electronic in the not-too-distant future. After all, he’s a mid-career physician, and it would be absurd to think of sticking with analog charts forever.

Late adopters like Kambelos represent an opportunity for health IT vendors, but one that will be challenging to capitalize on. As I wrote previously, future EMR-industry growth will require more resources and creativity to achieve.

More than 50 percent of physician offices have adopted an electronic records system, according to the U.S. Department of Health and Human Services. Among family physicians, one group of researchers found, the number is likely to exceed 80 percent this year.

In an interview, Kambelos explained why he practices — and thinks — the way he does.

Tell me about your practice.

It’s a large internal medicine practice with many elderly patients. I take care of generations of people, grandparents to grandkids. We know our patients and their families, and they know us. This has been, and remains, our patients’ “medical home.” I have two employees and they work hard.

What is record-keeping like in your practice?

I’ve practiced with paper charts for 17 years and they work fine for me. Many are very thick and chock-full of years of valuable and pertinent data. But I have my patients’ histories in my head and don’t need to be chained to a paper chart or an EMR to provide them with outstanding medical care and supervision. Most doctors who really know their patients can say the same.

Have you seriously considered moving to an EMR, and why?

Yes, for the supposed improved efficiency once fully implemented.

Are the Meaningful Use incentives much of a motivator?

Zero. The government is the biggest obstacle to health care delivery in this country.

Do vendors often reach out to you?

Periodically, we receive in-person and virtual solicitations. It happens a couple of times a month, perhaps.

Why haven’t you made the shift?

One reason and one reason only: the cost of making the transition, both in terms of my limited productivity during such a transition and the inherent labor costs in so doing.

In your view, what is the primary shortcoming of the systems out there?

Lack of interoperability. As I understand it, most EHRs don’t interface such that data across hospital systems is readily available to any given user.

What should EMR companies know about doctors like you?

We don’t fear, but rather embrace, new technology. But we work on tight budgets and cannot absorb the costs associated with transitions like this. Federal grants come nowhere near covering these costs and come with too many strings attached.

About the author

James Ritchie

James Ritchie

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.


  • Its True what Dr. Peter Kambelos is saying. For an individual practitioner implementing EMR will be a tough task.

    In the longer run if the EMR is implemented/practiced properly it can really save lots of time and money.

  • I don’t understand the reasoning. You’re going to be penalized soon for not adopting EMR. Right now, you can get MU incentive money but you’re worried about cost. The longer you wait, the greater the cost and less MU incentives…

  • What a great interview, John. Dr. Kambelos spends his time practicing medicine. He’s astute enough to let EMRs mature before committing, and is spot-on about gov’t being the biggest obstacle to health care delivery. He will eventually probably adopt a fairly simple easy-to-use model such as Dr. Chen’s NOSH open source offering (in related post #3).

    EMR vendors would be wise to read this post.

  • Malpractice attorney should read his post.. He sounds so uniformed – docs can get up to $44000 over the next few years to switch to an EHR (some of are free) plus free consulting plus position yourself for new payment models? What are his patient outcomes like?

    Nearly all docs think they are providing high quality care (half are below average) payment models are changing so his patients won’t have the care coordination that you can only achieve with an EHR and I doubt he knows what his outcomes or quality measures are either.. Quick how many of your diabetes patients or high BP patients have it under control?

    Sadly what will force him to change will be a lawsuit – Attorney ” so Dr you failed to catch this drug interaction or failed to see that your patient had just been discharged because you didnt’ want the EHR that the govt was willing to give you tens of thousands of dollars for along with free consulting services?”

  • The Dr’s point was clear. The ROI for him is zero or worse.

    Quick, how many of your diabetes or high BP patients actually even filled their prescriptions or took their meds today, or any day for that matter?

  • I get what he is saying, but where docs goof up is thinking they should handle this on their own.

    “He like to keep the government out of his exam room”
    In order to do this, you need to not take any money from the government.

    Just remember:
    There is no ROI.
    There is no increased efficiency, especially if you got rid of your transcriber, in seeing patients
    There is the greatly increased ability to monitor and report as @AXEO alluded to, but the day-in and day-out efficiency of seeing patients will not increase, and will probably decrease for a while.

  • Great comments here.

    John B., just to be clear, Dr. Kambelos did not make the statement about keeping the government out of the exam room. Those were my words based on my overall impression and the comment that he did make that “government is the biggest obstacle to health care delivery in this country.”

    It seemed logical to conclude that he doesn’t want the government in the exam room, but whether he would agree with those exact words, I don’t know.

  • What if you could have an EMR that was easy to use and had none of the downsides:
    – cost no more than your home cable package every month
    – no long term contract/commitment, no start-up fees, no interface fees
    – no requirement for hardware other than a laptop
    – no need to worry about backup, data archiving, or software updates
    – no time off practice for training for doctors or staff
    – no decreased patient volume during ramp up.

    I wouldn’t have thought these existed (based on my experience with three prior EMRs) but have happily found this with my current EMR (Elation).

    I have no financial interests in ElationEMR. I just like helping doctors find products that make their lives easier.


  • When considering EHR just remember you get what you pay for. Does free comply with the HIPAA/ HITECH compliance, among other regulations and requirements?

    Also by implementing the EHR database, not only do doctors stay on the same page with patient care, but it’s a network that opens the door for referrals. It’s a building block for enhanced resources in patient care.

  • Robin-Jo,
    Interesting question. Will doctors start only referring to doctors who have an EHR? At least that’s the question I took from your comments. Not sure if that’s what you intended. It will take a while, but I could see where the referral to someone who has an EHR is much better for a doctor that wants to get notes back or even automates the referral sending process.

  • John,

    At a point in time, yes doctors will only be referring to doctors with EHR, because that will be all that’s left, Doctors with EHR.

  • In the markets that I am familiar with, consolidation is the biggest factor in terms of referral patterns. Doctors sign on as employees of hospitals, and they refer primarily within that network. Since those systems do have EMRs, then yes, the physicians are are only referring to other doctors with EMRs, but the EMRs are not the root cause.

    The doctors who can remain indefinitely outside those systems are specialists who happen to be rare enough in the given community that they will get referrals no matter what.

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