David Burda’s piece on physician anger with Electronic Health Records is interesting (Alexis Polles is the original presenter). Modern Healthcare’s Daily Dose suggests these frustrations are related to poor design and poor training. Of course excellent design would minimize the need for training. I agree with that take.
However, the original speaker seems to indicate that some physicians are unable to adapt to this way of practicing medicine. Our experience is that 1 to 2 percent of doctors may have trouble embracing clinical IT (regardless of design and training). As you prepare to roll out your clinical IT systems I think it is critical to know how you will handle that 1 to 2 percent. I hear a lot of people talk about a “lack of senior management support” with clinical IT efforts. I think we put senior leaders in a tough position when the checks are signed and the physician problems beginning to pop up. If you have that conversation in advance and agree on the course of action, we will find senior leaders more support.
It will be useful to discuss some real uncomfortable scenarios. What if the one physician hold-out is your top admitter? What if you are experiencing 10% physician resistance? Too often we sugar coat these challenging projects. That will really cause a lack of senior leader support when your EHR or CPOE effort turns out to be something other than the bed of roses it was portrayed.
Candid CIO 
Interesting piece by David. I sometimes wonder if SOME of the frustration stems from electronic medical records vendors promising their EMR software can do everything under the sun with little or no effort, and physicians believing those sales pitches.
I have personally witnessed several physician practices express disappointment and anger about their EMR systems, only to become more positive after 6-9 months of use. Said another way, their opinion changes after they’ve worked out the initial kinks and familiarized themselves with the new technology. The first few months are the hardest.
I don’t intend to point a finger of blame at EMR vendors, but I often wonder how many physicians purchase these systems on the promise that you turn a switch and all your problems are forever solved. Unfortunately, even healthcare IT can’t solve every problem in the physician office. (It can do a lot, though!)
I’d be interested in hearing what others think.
EMR Software Guy
http://www.electronic-medical-record.blogspot.com/
on this page: http://blogs.msdn.com/healthblog/archive/2007/06/28/culture-and-age-as-an-impediment-to-the-adoption-of-healthcare-it.aspx
they chat about how older doctor simply lack patience to adopt the new IT technology.
I think that we’re at the healthcare IT tipping point. (Other industries have been reaping the benefits of IT for decades.) In any case, all the new doctors coming out of med school are steeped in the technology. Still, I’m not opposed to mandating the use of technology for the more recalcitrant doctors. We know its better and we know there are growing pains and temporary productivity losses, but the long term gains are certainly worth the pain.
Of course, what is really needed is accepted healthcare it standards for operation and interoperability. As well, the software needs to improve as to not be so difficult to use!
IT standards for healthcare is the key! I’m not talking HL7 stuff (of which who has adopted 3.0?).
What I’m talking about is healthcare leadership defining standards on what goes into the design. Too many times I’ve seen a product that does not provide industry common documentation. How does that happen? It happens because companies build on what they know, which is most likely outdated regulations as far as current healthcare practices are.
If healthcare leadership steps up to the plate to define these standards, and how to keep them up-to-date, we can get that well designed product that requires little training and wider acceptance.
Is anyone worried that perhaps we are missing the point.
Who are we going to be sharing information with?
There’s no incentive for EMR utilization in the field. Small practices (< 5 physicians) make up 95% of all ambulatory businesses (70% are solo) and see 70% of the 900 Million patient visits per year. These groups have seen their costs increase 40% since 2000 and revenues decline 17-35% depending upon who you ask.
Who are we going to share all of our information with if we drive physicians out of business? The largest study of EMR based practices (see below) shows adoption causes 15% productivity losses for up to a year. All joking aside, physicians are economically rational human beings. Until there is a clear, concrete, and solid benefit, (P4P isn’t even close) physicians won’t adopt EMR even if its free because productivity losses are economic suicide – especially when your margins are in a vice grip.
Are we building on sand? When it comes to choosing EMR, doctors have no choice. Yes, there are the case studies pampered by the vendors, led by strong executives, project managers, and retained earnings to weather the economic storm. For the general user though – the news isn’t all that bright as the largest and most independent studies have shown. (Notice you don’t hear much about these?)
EMR has NOT been shown to improve care:
http://news.yahoo.com/s/nm/records_dc;_ylt=AnDw8HYwnjuFZcfJWmQ3lEKs0NUE
HAS been shown to likely INCREASE the cost of Medicare
(http://content.healthaffairs.org/cgi/content/full/25/4/1079)
HAS been shown to cause productivity losses and no discernible ROI in the field :
(http://www.rpiusa.com/Con_05_Oct_slow_start%5B1%5D.pdf)