Seven Reasons Why Medical Practices Have Yet to Adopt EMRs

It is no secret. The majority of office-based physicians are not using EMR’s. According a recent article in FierceEMR only 6 percent are using a fully functioning EMR. I’ve read in other places adoption is as high as 15%. Still minuscule in the grand scheme of things.

Why is that? Why the slow adoption? Is it because docs fear technology? Is it because doc’s prefer the antiquated method of analog documentation? Is it because they see not added value in EMR’s?

In many circles, doc’s are criticized for their slow adoption. However, I’m going out on a limb here and suggest it is the fault of [most] EMR vendors that doctors have not fully adopted EMR’s in their practice.

Here is why:

1)      Too expensive: EMR’s have been around for at least 15 years, yet EMR vendors have yet to achieve economies of scale that reduce the price of EMR’s.

Imagine if a small business owner had to pay $6,000 or $12,000 for each license of Microsoft Office; how many small business owners would install MS Office at that price? A stripped consumer version of Adobe Photoshop runs for less than $100. A full version runs for less than $1000. I understand EMR’s are complex pieces of software, but does it really have to be that expensive?

EMR’s are so expensive that even the government realized  doctors’ adoption of EMR’s on their own merits was not feasible, so they will soon be offering up to $45,000 per physician to cover the cost. What does that tell you when the government has to step in?

2)      No Dominate Players: There are so many EMR vendors out there that it isn’t even funny. Deciding on which one is the best value for a practice is very difficult. Using the MS Office metaphor again, imagine having 20 or 30 different types of office productivity suites application to chose from, how would that affect the decision making process especially when one considers the wide range of options, prices, support that each one of these EMR vendors offers? Which brings me to my third reason…

3)       Too Many Choices: I’m all for choice, but when there are so many [unproven] companies out there, deciding on one is very overwhelming. It is like trying to choose a new breakfast cereal in the grocery store isle. There are so many cereal choices, one ends up sticking with the one you’ve been eating since you were a little kid.

4)      Locked in: Once a practice decides on a system, they are locked in due to the large investment. If the practice doesn’t like the system, if support stinks, if upgrades are few and far between (you know who you are), there is nothing a practice can do about it. Unfortunately, all the money to pay for the software is provided upfront; therefore walking out if things go sour is simply not a realistic option. This too is a hard pill to swallow for physicians.

5)      No Interoperability: Our EMR, despite being touted with all this HL7 compatibility stuff, doesn’t speak (computer language that is) with any other EMR on the planet (I can’t even send an electronic file to a doc with the same EMR software. I have to print it out for them, and they would have to scan it in). Thus, the efficiencies one would gain from being able to retrieve data from multiple area hospitals or other health care facilities and medical offices are non-existent. Imagine having one of those 3 and 1 machines (fax, copier, scanner), where the fax function doesn’t work because it can’t send or receive messages from any other fax on the planet.

6)      Productivity claims are misleading: EMR vendors love to sell the notion to doctors that with their EMR, they can see more patients and spend more time with their families. This is a little misleading. The fact is a doc can complete a paper chart, with their chicken scratch, faster then they can clicking and typing thru an EMR program.

EMR’s can enhance productivity (it can also hinder it as well), but not the way most EMR vendors plug it. For our practice, the core productivity enhancements are:

  1. Saves time tracking patient data
  2. Helps organize, automate and synchronize patient encounters
  3. Enhance physician documentation

Our EMR helps us be more organized, thus we are more productive. But the EMR (at least in our experience) doesn’t help doc’s work faster, thus be more productive. There is a distinction there.

7)      Too complicated in their design: One can tell by looking at [most] EMR’s, that an engineer designed it. What does that mean? The user interfaces looks like an old cockpit of a plane. There are so many buttons, it is hard to know where to look at first.

Doc’s are smart people, so they eventually figure it out if they have the motivation. But just like the rest of us, they like cool, sleek simple design too. As a little known designer said once, “simplicity is the ultimate sophistication.”EMR user interface have to improve in order to gain more adoption. Design matters!

UPDATE: I decided to post one more reason as a bonus point.

8)        Implementation is a pain:  About 2-month in of implementing our EMR, I called our EMR’s sales rep and told him to come get his software because we didn’t want it anymore. The implementation of the software was so overwhelming, so tedious, so backwards and so difficult that we thought we had made the wrong choice.

As it turned out, pretty much everybody I’ve come across that has adopted an EMR has had similar experience. We weren’t the only one. In our case, the EMR vendor did a poor job of managing our expectation, training was terrible and as a result, expectations did not meet reality.

When others hear these horror stories from people that have gone through the process, who would want to go through with something like this? That is why implementation has to improve in order to get more people to adopt EMR’s.

Do you agree? I’m sure there are EMR vendors out there that would disagree with me. Let me hear what your thoughts are.

For 11 more reasons why medical practices have yet to adopt EMR’s, check this link out here

18 thoughts on “Seven Reasons Why Medical Practices Have Yet to Adopt EMRs”

  1. Nice post. Agree with most everything. I have started using the webportal feature of my system and it has become a very important part of my practice. To directly interact with my patients in a secure manner has been awesome.

    I have saved signifcant space by not having 6k charts and at least a couple of employees, however some of that cost is offset by a monthly IT retainer and hardware costs.

    Also miss not being able to writes quick personal note about a family to ask the next time they come in.

  2. In my opinion, EMR vendors are competing and as a result they come into practices and say hey we have 100 features that this EMR has plus 10. It makes the EMR complicated.

    And please never trust anything that says FREE.

  3. Appreciate your comments Russell.

    I do disagree with something though.

    While finding out if an EMR vendor has practicing doctors on the dev team may be sound like a good idea, I don’t think it should be an issue. In fact, it should be tacit. It should be implicit that the EMR vendor took all possible considerations and exhausted all sources. Not just doctors.

    We don’t have to ask the people at Quicken if accountants or financial planners were part of the dev team when we buy their program.

    Same should be for EMR’s I think.

    Brandon

  4. Good discussion! As there are 100s of EMRs in the market, deciding would be difficult.

    Practices must look at vendors, where practicing doctors are part of the EMR Software Devp. Team so that the requirements of the doctors etc could be understood for modification of the software to meet specific requirements.

    One more suggestion would be to ask the EMR s/w company to run the solution as a service on a monthly fixed fees or other mutually agreeable payment mode. This way Doctors/Physicians/Practices etc can focus on their core business of proving quality health care and the S/W company can take care of the EMR part!

  5. Are these companies employing UI designers? Are they interviewing physicians to find out what THEY need? The reason the current crop of EMR products looks like the cockpit of an airplane is because engineers who build these EMRs are out of touch with what doctors actually need. They look at the data model and try to fit everything on the screen at once. Doctors don’t know what they want because when they look at these EMRs, they are so complicated they cannot visualise how these cumbersom systems will help them.

    1. Rob,

      I agree. I don’t think these companies are employing UI designers. That is why these EMR’s for the most part are ugly. Software, like food, has to be visually appealing in order for people to ‘want’ to use it.

      I’ve talked to EMR software engineers about this very topic. I tell them, this thing is ugly. And they usually respond… who cares if it is ugly. What matters is what is under the hood.

      Nowadays, everything matters. That includes the outside and the inside.

      Design matters. It sets the tone, the mood and the emotion.

      Thanks for the comment Rob.

  6. Brandon,

    You are right on! A couple of things we did to work around some of those issues, is to purchase an EMR that uses an ASP model (accessed via the internet rather than using in-house servers). It seemed clear to me as our search began, that if various entities ever achieve true interconnectivity, it will be via the internet, so using the ASP model seemed the clear choice. It also reduces the initial outlay dramatically, as the up-front costs do not include licenses, servers, thin-clients, etc., etc., You basically have a monthly subscription (not cheap), to continue using the software, but updates are done automatically via the internet, with training and everything. There are no monthly hardware maintenance fees – you operate off standard PCs, laptops or tablets.

    With ASP model, a full time IT person is not necessary, but someone in the practice has to be available and somewhat knowledgeable about IT, or at least troubleshooting to the point they can report accurately to an outside IT firm what the problem is.

    Just as important is a physician champion in the practice who can really take the lead, for at least a year, in development of clinical documentation and template work, which is vital for customizing the EMR so it is user friendly for all the providers in the practice. In lieu of a physician, someone with a strong clinical background is definitely required.

    Production is definitely affected, not as bad as we thought at first, but because the EMR reminds you to perform all the components of the visit and document thoroughly, it does “seem” to take more time, although in reality, used properly, taking advantage of all the customization features your EMR has, it can actually save documentation time in the long run. E-prescribing is absolutely phenomenal. ASP model also makes great use of faxing all sorts of documents, and works very well for us.

    Lab interface has been the most significant struggle for us. I basically had to declare war on the computer vendor AND the lab equipment vendor to get anything accomplished, and it still took 6 months. I don’t pretend to understand it, but as you said, it is an extremely laborious and technical project, requiring lots of collaboration.

    We had already made our decision to purchase EMR in the fall of 2008 before we knew about the HITECH act and any possibility of receiving financial assistance. We are so glad we got ahead of the rush that is going on now to get in on it. While it was a painful process at times, no one here would go back to paper, and we haven’t met anyone else who took the plunge that would go back either.

    My advice, talk to as many people who have EMR as you can, go into their practice and observe closely how things work after EMR, and definitely take a look at the ASP model.

    1. I agree. The ASP model does have many advantages. And it does eliminate some of the challenges a non ASP model provides. But just like anything else, it also has disadvantages.

      When we were looking for an EMR seven years ago, there weren’t too many EMR vendors that provided an ASP model. But I would have definitely considered one had there been one available to consider.

      Don’t get me started with lab interfaces. Our EMR vendor has refused to work with Quest Diagnostics in developing a lab interface. I don’t know who’s at fault, but what I do know, is that we are losing out as a result. And there is nothing we can do about it.

      Your experience seems to be very common. And that is the problem I have with EMR vendors. It is a hassle and it is complicated. I have yet to meet a person that has implemented an EMR that hasn’t gone through difficulties. Don’t get me wrong, I understand things are not perfect. But c’mon. Horror stories are the norm. That’s just not right.

      Thank you for stopping by and giving your perspective. I’m sure others that are looking into an EMR will consider a vendor that offers an ASP model.

      If you want to know what an ASP is, check out this link ASP stand for Application Service Provider.

  7. Great post, Brandon! I like the perspectives you share from your own experience – very meaningful. Thanks also for linking to my post on the topic.

    Best wishes,

    Mary Pat

    1. This is a great post. It brings up important barriers to EHR/EMR adoption, and there are no quick fixes to address these barriers. Therefore, it is understandable that physicians meet EHR/EMRs with resistance. Physicians need to be as educated as possible about EHR/EMR preparation, selection, and implementation, and unfortunately there are not a lot of unbiased resources available. I did find one unbiased source with a lot of very helpful information on EHR/EMRs and the Health IT industry in general. If you are interested, resources are available here: http://www.ehrscope.com/

      1. Actually, I think there could be quick fixes to overcome these barriers. All one has to do is look at other industries with similar business dynamics and adopt what they are doing.

        Why aren’t there issues in adopting software packages like Photoshop, Quicken, MS Office or even online services such as Mint.com? Sure, there might be training issues, but we don’t have “adoption” issues.

        This whole notion that doctors need to educate themselves as much as possible in the preparation, selection and implementation is crazy. They don’t have time for that. All that they need is software that that is easy, intuitive (pretty looking, remember, design matters) and that it works.

        There is software like that already out there. Just not in the medical field.

        Thanks for the comments.

        Brandon

    2. No problem…

      What I liked about your post, is that you too posted from your own experience which was a completely different perspective than mine. Despite the difference in issues, we both agree that there are many hurdles and challenges med practices have to overcome. And more to my point, EMR vendors have not done a very good job in making it easier for doc’s to adopt EMR’s.

      Appreciate the positive feedback.

      Brandon

      And until EMR’s

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