A new landmark study on EHRs was published this week, and its implications for widespread physician adoption of traditional (“legacy”) EHR technology—particularly by high-performance specialists—are dismal. Published on December 14 in the well-respected Milbank Quarterly, the study represents the most thorough EHR analysis to-date, basing its conclusions on an exhaustive review of 195 previous studies. Confirming the previously acknowledged EHR failure rate of 50%—quoted by then “IT Czar” David Brailer, M.D.—the lead author estimated the actual failure rate to be as high as 50%-80% of implementations, as reported in Healthcare IT News.
The authors cite several reasons for the failures, similar to the points I have presented in past EMR Straight Talk posts. Among the major conclusions reported were the following:
- While secondary work like audit, research, and billing may be made more efficient by EHRs, primary clinical work is often made less efficient;
- The larger the project, the more likely it is to fail; and
- EHRs do not adequately capture the messiness and unpredictability of the real world.
In other words, legacy EHRs do not benefit physicians, but rather force them to change the way they practice medicine. They fail to give them the tools and flexibility to solve real world problems and to effectively deal with the realities of day-to-day practice. Legacy EHRs “straight-jacket” physicians—requiring them to point-and-click their way through the documentation of patient exams, produce robotic notes, shift their focus away from the patient, and decrease productivity. They do not distinguish the needs of primary care from those of specialists. It is no surprise that implementations fail, and that high-volume specialty practices face the greatest risk.
Like me, however, the authors are not anti-EHR. They realize the need for new strategies and suggest encompassing “imagination and flexibility to overcome the inherent limitations [of existing EHRs].” As readers of EMR Straight Talk know, I have been a proponent of this approach to addressing the needs of high performance physicians. Based on the unparalleled success that our company’s hybrid EMR has in making physicians digital, efficient, and able to provide better patient care, I am sharing our action plan with the EHR vendor community:
- Adopt a laser-like focus on the needs of physicians.
- Invest precious R&D dollars in developing those software features that digitize the medical practice and automate routine clinical processes—those that, in the paper world, create intractable workflow bottlenecks and sub-optimal patient care.
- Convert paper charts to efficient digital, shareable, and portable formats.
- Address the need for speed—count the number of clicks required to accomplish basic tasks and cut it in half. Measure the amount of mouse movement it takes to do the same tasks and reduce that by half.
- Allocate 75% of your programming budget to features that the support and implementation teams want—if it makes a support technician or implementation specialist happy, it will no doubt make clients happy.
- Assure customers’ success—move on to the next implementation only after the current implementation is deemed a success by the client (no matter how much Wall Street or your investors are breathing down your neck for revenue growth).
- Implement an ‘open checkbook’ policy for your support department to hire as many employees as it takes to please your clients—happy clients are your best marketing.
- Hire only ETPs (“eager-to-please” employees) who will always go out of their way to please clients.
If we address the fundamental problems inherent in legacy EHRs and focus on the needs of physicians, adoption will flourish and meeting the goals of the other stakeholders—patients, government, payers, and vendors—will naturally follow.
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Your post makes many points that are not mentioned often enough in most EHR related articles-Hopefully those involved in the future development and regulation of EHRs take note and pay attention.
Best wishes to you and the entire SRS staff for the holidays and New Year !
This research speaks directly to the experiences of my client. They are a small oncology practice in Western North Carolina and about two years ago tried an EMR product from one of the large vendors (I won’t say which one). The efficiency of the office degraded so much that they were enthusiastic about switching back to paper.
Their solution was to hire a programmer (me) to implement custom software that was 110% focused on their workflow. We realized that the failure point of a lot of EMR implementations were due to good salesmanship on the part of the vendor. I spend a good amount of time ghosting nurses and doctors, taking notes in order to build the best-fitting product possible. I especially like your term ‘laser-focused approach’ because that is exactly how I am tackling this problem. I am chronicling the insights, design decisions, failures and successes at my blog.