The paltry adoption rate, high failure rate, and increasing number of de-installations all indicate that the process typically used to make EMR purchase decisions is seriously flawed. So how does a practice avoid making the wrong choice and buying EMR software that does not meet the needs of its physicians? I believe that they must fundamentally alter the evaluation process.
The typical process relinquishes too much power to the vendors. The practice convenes a committee that conducts a cursory review of (typically) name-brand EMRs, narrows the list down to three or four vendors, and invites the vendors to put on a “Dog and Pony Show.” Each vendor comes with a flashy presentation, shows a structured demo using a “canned” patient with a simple problem, provides several references of happy customers, and predicts a sizeable and rapid ROI. They then offer to introduce the practice to a showcase client. The problem: This process gives the physicians no way of predicting the effect on productivity, or of evaluating usability and comparative efficiency. Most importantly, physicians are left blissfully unaware of the historic failure rate of each of the EMRs they are considering.
The following are some suggestions for a more meaningful evaluation process, one that restores the power to you—the physicians and practices—and yields more realistic and valuable information:
- Invite (i.e., require) vendors to participate in a side-by-side comparison test, which will allow you to benchmark the number of clicks it takes to accomplish the most common practice workflow tasks. Focus on the 20% of the tasks that make up 80% of a typical physician and office staff workflow—reviewing specific chart information before seeing a patient, signing off on a message, reviewing labs, or generating a prescription, for example. The other fancy features touted by EMRs are irrelevant to productivity. Clicks are time, and time is money, so this analysis will provide a true measure of relative efficiency and opportunity for increased revenue and profit generation.
- Use real patients with typical clinical presentations, or simulated patients of your design—not the standard patient used in the vendor’s demo. This information will be directly relevant to your physicians and will demonstrate how usable and flexible each EMR is for you.
- Ask for the names of 20 clients of your practice’s specialty and size who have recently purchased and implemented each vendor’s EMR. This will give a better idea of the vendor’s depth of experience with your type of physicians. Don’t rely on the vendor’s references—do your own networking and research. This is the only way to uncover the not-so-successful implementations in addition to the well-marketed successes.
- When negotiating contracts, ensure that the physicians are protected on the down side—insist on having the option to be refunded the entire purchase price of the software if physicians do not adopt it. This will demonstrate the vendor‘s confidence (or lack or confidence) in their product and will ensure that you will get the highest level of implementation services and support. You must protect yourself from vendors who are anticipating a crush of orders stemming from the Stimulus Plan and who will send green employees to manage your implementation, thereby reducing your chances of success.
EMR Reform, outlined in a past blog, would dramatically facilitate this process, adding necessary transparency and restoring the balance between physicians and providers.