EHR Success: What is the Reality?

With the constant barrage of meaningful use success stories in the media—number of providers enrolled, dollars of incentives earned, and case studies about practices that have already received their money—it pains me to see that the experience on the ground quite often does not reflect this reality. Although they are only anecdotal, let me share two recent personal stories that I fear are representative of all too common EHR implementation failures.

I recently visited my dermatologist, whose practice purchased an EHR approximately 2 years ago (not my company’s product). When I arrived, I saw to my dismay that the office looked and operated exactly as it had before they bought the EHR—there were walls of charts; no computers in or around the exam rooms; and my physician walked in grasping my paper chart in his hand, with loosely assembled documents protruding from the edges. When I asked why they were still using paper charts, I was told that “it takes a long time to switch over to computers!” No one in the office—not the front desk staff, not the clinical staff, and not my physician—could even tell me the name of the EHR they had purchased. Clearly, little—if any—progress had been made on the implementation front in the 2 years since the purchase decision, and yet they seemed to think this lack of a transition was normal. All that money invested, and no return!

A visit to my primary care physician was equally disturbing, but from another perspective. His practice had implemented an EHR (also not my company’s product), and several of the physicians were, in fact, using the software—but not happily. He complained that he was seeing fewer patients each day, as well as staying a half hour longer to catch up on his documentation. Will he earn a meaningful use incentive? Likely yes, but at what cost?

I have always maintained that government incentives should not be the motivation for adopting an EHR. Practice improvement—cost reduction, increased productivity, and better patient care—should be the driver. With the rapidly increasing demand for care and the growing shortage of physicians, the need for easily implementable, productivity-enhancing EHR technology is indisputable, and yet so many EHR implementations are still failing. How do we as an industry address this shortcoming?

9 thoughts on “EHR Success: What is the Reality?

  1. Evan,

    A local 35 man urology practice was aquired by the hospital and converted to EPIC in the office, now they have decided to go back to private practice, they then decided to stay on EPIC rather than buy a new EMR but plan to hire “Scribes” to follow each doctor in the office to deal with their EMR. This is probably the most expensive option I could think imagine! Vince

  2. Evan, I appreciate your stories and I agree that they are disturbing. The other side: I have heard plenty stories from groups who have implemented (complete) EHR and had the opposite experience: workflow changed for the better, productivity did not drop (and for some groups increased), and clinicians and patients had better access to medical information. Sometimes I find that SRS Soft seems to be critical of EHR’s (complete) and does not recognize the value of structured data and groups who embrace making the workflow changes to avoid productivity decreases. We are on SRS, and I am looking forward to the future improvements in the product that will allow us to get some clinical data stored as structured rather than pdf format.

    Thank you.

    [Evan Steele says:]

    Adele,
    I agree with many of your comments–there are practices that have had positive experiences with EHR implementations, but sadly there are still too many like the ones I recounted.

    Regarding SRS, we have made the product improvements that you seek. SRS EHR has introduced a new, discrete data platform and the SRS EHR is now ONC certified as a complete EHR. We look forward to upgrading your practice so that you can take advantage of the new capabilities and earn the government’s meaningful use incentives.

  3. I’m conflicted about the EHR meaningful use incentives. I’m a big believer in integrating EHRs into the workplace, but if EHR companies aren’t providing a product that is adequate (such as the one mentioned in your second example), then they shouldn’t be used. EHRs should be implemented in offices if they correctly serve their purpose of improving both efficiency and data storage. The meaningful use incentive keeps poorly designed EHRs in the market with very little accountability to improve their systems. Thoughts?
    Daniel

  4. Re- How does meaningful use translate into meaningful care…it doesn’t. The meaningful use criteria checks to see if your system has some key parts such as CPOE, access controls, med allergy checks, etc. It’s as if the government said in order to have a certified safe automobile you need brakes, and steering wheel, and a horn. How they work together (if at all) is not part of the criteria. Hence certification can not/does not guarantee meaningful care.
    Frank Poggio

  5. Evan,
    Agree completely with your “government incentive” carrot and stick approach. Continuous contact with practices suffering more or less “permanent” reduction in physician productivity, higher overhead costs, and reduced quality of documentation. As a patient at my recent GP visit, I found myself to be a “spectator” to my documentation process as my physician dictated and corrected his Voice Recognition notes. To get his attention, I began referring to myself in the third person!
    The evolution of software in the private sector from the days of IBM mainframes has been long, but driven by market economics, delivering costs reductions and productivity gains, incentive enough. I don’t recall any government mandates suggesting companies buy desktops, or the taxing of typewriters at the time to encourage the market.
    Isn’t there a similar process going on with renewable energy (solar and wind) making everyone feel good at a greater and typically hidden cost?

  6. “Change is difficult”. That single phrase repeats in my head over and over as I read this article.

    As a veteran of over 200+ EHR unique implementations, over the past 9 years, the one thing that I am most certain of, in relation to this subject, is the fact that people inherently do not like to change.

    Essentially, what the ONC has done with the meaningful use program is “strike the first chord” of the opening sonata in a grand symphony orchestra. The vision is long-term, and the overall benefits will not be realized for quite some time.

    But, as with every amazing composition, it takes a the full instrumental ensemble to make great music, together. The orchestra must be willing to play the next note, the next verse. But, that takes time and training, and yes some failure too.

    So, in order to foster change, the ONC has attempted to lower the perceived pain of adoption though the use of incentive payments. And of course, they’ve already established a crisis through the program by issuing penalties if one does not adopt a certified EHR technology.

    Change is difficult, but we have to start somewhere.

  7. You also don’t highlight the problem of implementing an EMR in your practice and then the options you have available to you after the implementation. Sure, you could switch to another EMR, but the costs of switching are very high and extremely challenging. Of course, after a couple of years hating your EMR, you do generally make a better selection decision the second time and the costs seem minor compared to your dislike of a poor EMR in your practice.

  8. Many electronic medical record systems are supported every day mechanically and are accessible almost anywhere on the planet. Besides improving care for patients, another edge of EMR integration is that it can reduce costs for physicians. Unnecessary staff costs and storage costs are eliminated with electronic medical records storage because they use up less space and are more easily obtainable than paper versions.

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