Thank you for your blog comments.

First let me clarify your misconception regarding the SRS hybrid EMR—it is not merely a scanning system, but rather a physician-driven EMR that does not reduce productivity. The fact that we have not chosen to construct our EMR around CCHIT criteria does not mean that our product is not an EMR. The SRS hybrid EMR has many areas of optional data entry, data management, and interoperability—including ePrescribing, PQRI management, treatment recommendations/decision support, discrete data-based problems and procedure lists, and databased lab values. Our clients have successfully shared data with RHIOs, etc.

When I write about EMR implementation challenges, I’m referring to the high-performance, high-volume physicians where CCHIT-type EMRs have had a dismal track record—particularly in the larger, physician-owned, non-academic group practices. Many in the industry talk about EMR successes, but the body of research does not support the financial benefits to physicians of traditional, point-and-click data entry EMRs. There have been many landmark studies that conclude that traditional EMRs cause financial harm to physicians, but I have yet to find just ONE landmark study performed by a venerable institution that is non-vendor funded that concludes otherwise (if you find one, please forward it to me).

There are certainly physicians that have worked their way up the learning curve and implemented traditional EMRs—but these tend to be primary-care practices where productivity losses stemming from EMR use are not as magnified as they are in the high-performance segment of the market. They remain, however, the vast minority.

I believe it is naïve to expect that a class of products (i.e., traditional, data-entry EMR)—that has an unproven and unsubstantiated track record of success in addition to returning no financial benefit to physicians—will be implementable on a nationwide scale. The interoperability and sharing of data is still far from a realistic capability of even CCHIT-certified EMRs. These are the facts that form the basis of my skepticism.

The other factor you fail to take into account is learning curve. While it is undoubtedly true that there have been major failures implementing EMRs, the failures (a) are NOT LIMITED TO CCHIT-certified products and (b) have as much to do with physician reluctance to adopt the technology as anything else. People do not like change. My own experience with EMR implementations (about 20 of them, but not in a research study) is this: (a) if the practice is owned by a physician who has a financial stake in the outcome, the implementation typically succeeds; (b),
if the docs practice ahead of Go Live, they typically love the system ~ although it depends on the system and its friendliness, of course, its ability to be tailored, etc.) and (c) the young physicians who have used EMRs from the beginning or since near the beginning of their careers, are quick to adapt.

Your arguments, while equally self-interested as the big CCHIT companies, do not take into account that any change of this magnitude in ANY industry takes years and years to accomplish. In an industry that is 1/6 our GNP, as you point out, I think it’s absurd to expect that all attempts at innovation will be successful. Your facts may be correct (EMR implementations have met with widespread failure) but the CONTEXT in which you interpret the facts is extremely narrow and self-interested. Anyone who has spent any serious time in the health records field knows better.