If you comb through the blogosphere on the topic of electronic medical records, you may find a surprising amount of negative commentary. And if you mention the financial incentives for meaningful use implementation, things get downright testy: anti-government sentiment, conspiracy theories, and a call to resist the temptation to go paperless. They site studies that show that EMR has failed to improve practice efficiencies or control costs, as well as high failure rates leading to many doctors losing money. Why all the controversy now?
I think what we are experiencing is the high middle of the market adoption curve of these systems. There are many early adopter practices that have been successfully using EMR for years but now we are starting to see the more conservative and skeptical practitioners jump into the game, with very mixed results: failed implementations and abandonment, multiple purchases leading to significant write-offs, or incomplete implementations which are barely limping along. The culprit, according to these unfortunate practices, is conveniently the software itself.
But the high failure rate of EMR system implementation (30-50% in most studies) is not so much a reflection of the technology as a lack of knowledge of basic change management on the part of physicians. We don’t learn anything about business in medical school and we certainly don’t learn how to integrate complex technologies such as EMR into a small business. But it is a people management issue not a tool management one.
I disagree that EMR systems are by definition inefficient and that they don’t improve productivity. We have not found this to be the case in our own practice after 3 1/2 years of EMR use – and we have only begun to realize its full potential. But what most practices don’t realize is that it is just part of an overall sea-change in the way you practice medicine. Even the best EMR system cannot fix poor workflow processes – if anything, it will make them more obvious. Our EMR implementation was planned for 3 years before we went live and the software wasn’t chosen until half way through this process. Most doctors run out and buy the first EMR they fall in love with and then make their administrator try to implement it in three months – this is like buying a new tool and then trying to figure out how to use it.
Some feel that the financial incentives from the government, with complicity on the part of insurance companies, will ultimately prove to be a clever way of controlling physicians through the lens of promoting ‘better’ healthcare delivery. And true, any time that the government and private carriers agree on something, you have to pause and think. Rather than having to cull through stacks of paper charts, auditors can now make you upload your entire file set for their bots to search through.
But EMR systems are here to stay. Electronic practice management systems replaced paper scheduler and pegboard ledger books and paper medical records will soon be a thing of the past. Physicians can be resistant and be dragged kicking and screaming into the 21st Century. Or they can get educated and informed, perform their due diligence, and realize that this will be the most expensive and difficult thing they will have to do in their career – besides raising kids.