Enterprise EMR: One Size Does Not Fit All

In my recent post on the industry-leading EMR blog HIStalk, I discussed the impossibility of one type of EMR ever meeting the needs of all the disparate types of providers. Among the arguments I presented was that it is impossible for the same EMR product to satisfy both hospitals and private-practice physicians. Enterprise EMRs simply do not work in high-volume ambulatory settings, and it is unrealistic to expect that they would.

Apparently, this hit a nerve, given the passion and intensity of the comments, most of which addressed Epic. (You can read the comments by clicking here.) In response to Peppermint Patty’s claim that “tens of thousands of happy specialists use Epic,” Epic Mythology replied, “The idea that all specialists, or users in general, are happy with Epic is a flat-out lie. My own academic specialty clinic rebelled against Epic’s ambulatory interface as long as we could, and we switched only by force. It destroyed my clinic workflow, and I now see fewer patients while spending longer documenting. . . . I have yet to meet any doctor who really likes Epic.”

There you have it—the basic problem in our industry identified very simply by the argument between Peppermint Patty and Epic Mythology. How do we know who is right? These and several of the other comments beg the question of how a specialist—or any physician—can ferret out the truth about the potential of Epic (or any other enterprise EMR) to satisfy his or her practice’s needs? This is becoming an increasingly critical issue, given the growing pressure hospitals are putting on physicians to adopt the enterprise system by subsidizing the cost. Are physicians who succumb to this pressure getting what is right for their practices?

The following is the comment I added to HIStalk following the initial set of responses to my “Reader’s Write” post:

Judging by the comments to my post, the implementation of enterprise EMRs in ambulatory practices is a major issue confronting physicians. Most of the comments focus on Epic, the dominant player in that market. Peppermint Patty and Epic Mythology sum up the two positions—the former claims that there are many happy users of Epic, while the latter argues the exact opposite. Who is right? And how do we find out for sure? My experience speaking with thousands of physicians over the years supports Epic Mythology’s position—like him, I have not met many specialists satisfied with using enterprise EMR systems in their private practices.

Given the revived interest in EMR purchases, it’s critical for the physician community to know the truth.

Please continue the conversation by commenting on EMR Straight Talk (below) or by joining the dialogue on HIStalk.

3 thoughts on “Enterprise EMR: One Size Does Not Fit All

  1. I doubt that you’ll ever get to the “truth” on this topic.

    One big reason is that Epic’s “Good Install Program” requires users to unequivocally say they are “happy” with the product — as measured in the “User Happiness Survey” administered by Epic — in order for the healthcare organization to get a “rebate” or “refund” of up to 20% of the installation costs.

    There’s no chance that a sane user is going to report anything other than being “happy” with that product if he/she expects to keep their job.

  2. EPIC and enterprise EMRs have no place in physician documentation. Yes there are many advantages, but physicians will all say that an electronic template driven system such as EPIC does not meet the demands of physicians. Enterprise EMRs are turning highly educated individuals into transcriptionists. In our ED we have had to hire extra nurse practitioners to help us keep up with the flow. We still are not as efficient when transcription was in place.

    Multiply this all over medicine and what does this add to the cost and inefficiency of medicine? Not even taking into account the frustration and the medical legal ramifications which books will be written about once the courthouses settle some of these cases. If someone would ever develop a hospital or even a clinic where the only responsibility of a physician was see and talk or operate on patients FACE TO FACE and not be bothered with EMR work, you would free up the most efficient machine yet created to practice medicine. The human mind.

    Paul Orcutt, MD FACEP

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