Physicians Spooked by Failure Stories—EHR Adoption Suffers

Physicians Spooked by Failure StoriesA significant portion of the physician market has still not adopted an EHR, despite the lure of government incentives and the fear of the penalties looming on the horizon. The stock prices of most publicly traded ambulatory EHR companies are down sharply, as sales are lower and earnings projections have not been met throughout the industry. How can this be, when the EHR incentive program has successfully increased EHR adoption and was expected to be such a boon to EHR vendors?

I know why, and it is not—as commonly thought—because the initial EHR-adoption rush fostered by the incentives has ended. Rather, it is because of rampant physician dissatisfaction that has reached a more-than-palpable level. I have noticed a dramatic change in the tenor of conversations with physicians, most recently at professional society conferences, where physicians who have not yet purchased an EHR are frozen in their tracks. They are worried by the horror stories they hear from colleagues—even from those who have succeeded at meaningful use—because many of those physicians continue to experience major workflow disruptions and significant productivity losses from which they see no potential to rebound. Recent surveys point to the number of physicians looking to replace their EHRs, and based on my company’s experience in the replacement market, that number is growing. A recent article summarized the findings of a large study on EHR satisfaction and presented an insightful analysis of the potential reasons for these disappointing results.

This heightened level of frustration has resulted from frantic, insufficiently researched EHR purchase decisions by physicians and rushed, inadequate implementations conducted by resource-strapped vendors. Massive EHR failures are exactly what I predicted in an EMR Straight Talk post on the unintended consequences of the EHR incentive program in February 2010:

After an initial peak in implementations, long-term EHR adoption will slow—particularly among high-performance specialists—and the current failure rate will escalate. Many factors will contribute to this: (1) Some physicians will rush into EHR purchases without conducting proper due diligence. (2) Products that were overly complex and did not work in busy specialists’ practices in the past will surely not succeed now, particularly since these same products must now be used in an even more structured and demanding way. (3) Sorely needed implementation and training will be provided by inexperienced and rushed implementation teams, further reducing the likelihood of success with providers, many of whom are less technologically savvy than the early adopters. (4) Where there was never a convincing economic justification in the past, the addition of data-collection requirements will further lessen the economic feasibility of traditional, point-and-click EHRs. . . . The result? The high failure rate will leave physicians “holding the bag” after investing large sums of money, failing to earn the anticipated incentives, and owning a system that doesn’t meet their needs.

So, what can physicians do to avoid falling victim to EHR failure, and to instead reap the benefits of successful EHR adoption—government incentives and practice productivity? I have written extensively about the importance of physicians doing thorough and objective reference checking—that advice is as valid now as when I first wrote about it, and perhaps is even more critical today. For guidance on how to conduct a thorough and fair evaluation of an EHR, read EMR Selection: How to Uncover the Truth or 100% EHR Success – A Clinical Approach.

10 thoughts on “Physicians Spooked by Failure Stories—EHR Adoption Suffers

  1. I have been successful in my comprehensive ophthalmic practice with EMR for almost 7 years. Every system requires effort, commitment, and due diligence. But to be really efficient and happy with whatever system you commit to, it is summed up in one word. SCRIBE! You absolutely must have a scribe or even two! This is the key. The physician is free to practice and the scribe is responsible for the documentation. It all flows very well when all the parts are working. I will continue to enjoy a growing practice with extremely satisfied staff and patients do to the careful orchestration of the patient visit.

  2. I am a non-adopter and likely will remain so. I am a solo specialist. I fail to see at all any financial advantage to EHRs. The incentive barely covers the cost, and it is taxable so already there is a net loss. Add to this the cost of annual updates, a need to buy new hardware every so often and the trivial penalty from Medicare only which would amount to less than 1/4th of 1% of my total income, and I see no reason to change. The dissatisfaction with training time, computer down time, physician time spent nursing a computer with inflexible program needs leading to less time with the patient add to the risk. Even the assumed ease of transfer of date is not there since most programs fail to “talk” to each other is simply not there. My practice does fine, thank you, with paper records and unless I see a huge shift to address these problems, I will continue not losing money by adopting an EHR.

  3. The world is shifting to value based models of care that reward quality, outcomes and population health. When are you going to stop complaining about “reduced physician efficiency” and start being part of the solution rather than part of the problem?

    You are a real whiner, Evan

    [Evan Steele says:]
    I believe the first step to improving patient care is to make physicians and staff more efficient. Any business that uses technology to become more efficient takes better care of its customers (i.e., the patients). Only when medical practice operate at peak efficiency, can discrete clinical data be collected effectively and accurately which, in turn, drives higher quality and better outcomes.

  4. Smarter systems, smarter systems, smarter systems. Starting with the user experience and workflow requirements and programming to match rather than vice versa (as is true for the VAST majority of current EHRs) is key. There are but a few such systems out there that are designed as such, but they are all about the provider experience and they are a joy to use.

    Sorry to hear that Richard feels as he does. Using an EHR isn’t about the money, at least in my humble opinion it isn’t. It’s about being a part of doing the right thing. We’re still in the infancy of healthcare digitization, so of course it’s painful. Raising baby isn’t about cost savings or avoiding sleepless nights and parental angst. It’s about doing what’s right, doing what’s needed, to raise a child that will become a well-adjusted addition to the world. And, honestly, is there any way to say that the “adult” paper medical record has any real remaining value given our full-blown and ever-growing information explosion? None that I can see, at least not if you look past the very short term and exquisitely localized view.

  5. Promises, promises, all the things the EMR was supposed to do, all the support that disappeared once the product was bought. We have many “EMR compatible machines (visual fields, ocular pressures…) ” none easily communicate with the EMR which touted being able to support inputing the information…. yes they will support it, if you pay not only the EMR company but the Machine company as well, thousands, yes thousand of dollars… per machine. Not to mention that our office works with over 18 different hospitals and labs, none of which can communicate with us or each other, without buying and installing proprietary software….FOR EACH COMPUTER/USER that may log in. Yes we have an EMR, but we do our notes by hand, and just scan them in….too much BS trying to develop a program that will allow the tech, the ancillary staff, and the MD, to all work on the same shared chart, electronically, as well as do drawings… EMR is not ready for the real Doctors office.

  6. I’m going to say that a key here with physician dissatisfaction with an EMR is primarily one of setting appropriate expectations. I was a consultant for several years, and during that time analyzed workflows from hundreds of different physician offices all over the country. Amongst all of them, there is surprisingly little that’s the same. What that does is present EMR devs with a bear of a task to write software that actually fills the workflow needs of physicians with wildly different workflows. It’s not easy.

    I think a key piece that’s often left out of discussions on EMR adoption is that an EMR – ANY EMR will fundamentally change the way your practice works. Many physicians approach an EMR implementation with the assumption that software can immediately imitate their workflows with no issue whatsoever. I think more physicians would be satisfied with their current EMRs if they had realistic expectations of what installing an EMR means for them as an organization, and the kinds of organization changes that an EMR will bring with it.

    If you couple that with the sales people who no doubt ‘fudge’ the facts, promise things without checking with their developers to see if its possible resulting in things being promised to physicians that were never possible to begin with — and you’ve got a lot of dissatisfied people. On every install I worked on, I said time and time again that communication from the CIO all the way down to the part time scheduler is imperative to have a successful implementation.

  7. I see the good & the bad of EHR. The good is having a patient’s full medical history available ASAP, creating little or no delay in treatment of a patient’s condition(s), particularly those that are sudden &/or serious. The secure access and exchange of information can only benefit everyone involved. The bad is in inproper training of individuals handling records, which is probably more applicable to the “infancy” period, and the possibility of down-time on any EHR system, which I feel we have had more than our fair share of for whatever reason. I feel that this will all improve over time & anyone not currently involved will eventually be left behind since everyone else will have this method of communication and information exchange.

  8. There’s a missing piece here as well – the culture of providers – a culture that stresses autonomy and medicine as an art over regulation and medicine as a commodity. Technology is seen as a third-wheel in the patient/provider relationships, and any inclination that it has affects on clinical decision making is sure to deter providers. Most physicians (particularly small practice ones) see the MU requirements as excessive and inappropriate, and protest government regulation of their industry. Much of the dissatisfaction can be found with the policies forcing EHR adoption as much as the EHRs themselves.

  9. I am probably too late for this discussion, but I just found this blog and would like to “insert my 5 cents”. You are absolutely right – all the modern computer systems help to satisfy multiple requirements imposed on physicians by the government and insurances, but even the better ones do not help in automation of the workflow in the office. And they probably cannot for a reason: practicing medicine is not a precise science and each physician (even within the same office) may have a different workflow to which EMR/EHR systems have little flexibility to adapt. The other reason is that these systems are “stupid” – they always follow you instead of leading and helping you applying the rules you set and your patterns and experience to each patient you see. The above is called software intelligence and analytics and all the modern EMR/EHR systems do not have them at all or at a very limited level. But once the software becomes intelligent – the physician performance increases and the stress goes down.

  10. I strongly agree with Dr. Greg. Smarter systems are key.

    Also, I think things will become easier as new physicians and medical professionals enter the workplace already expecting to use EHRs (just like physicians used to enter the field feeling comfortable with a piece of paper and a pen for charts).

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