Electronic Health Record Adoption Problems

One of the reasons that medical practices are stating that they are not adopting Electronic Health Records (EHR) is that there are too many choices. Couple this with the failure rates of EHR early adopters - now most medical offices are choosing not to choose. However, if doctors could only find the right products and companies, the reasons to adopt technology far outweigh the reasons to avoid it.

As with any technology solution, electronic health records software can boost productivity and improve workflow processes. One of the key benefit categories of an EHR system is the elimination of paper. Most medical practices use paper exclusively to keep their patient records. EHR eliminates this paper. To the naked eye, this may not seem like much. However, the cost savings can easily be quantified.

First, eliminate the storage areas of that paper. If a practice uses 1000 square feet to store their paper charts, this could easily be converted into revenue producing space such as procedure rooms, CT, MRI, or X-ray equipment rooms, exam rooms, or physician offices. The practice could also eliminate that space and reduce rent or storage space costs.

Second, the cost of managing that paper could be eliminated. This is less quantifiable, but toner, paper costs, plus the cost of a chart folder are easily quantified - take the number of new patients seen per day, week, or month, and multiply that by the cost of a new paper chart. The big cost savings is in the reduction of staff time managing that paper - photocopying, looking for lost charts, filing, pulling charts, etc.

Third, some EHR software contains charting solutions that could be used by the doctors to eliminate transcription costs. Doctors should hold their expectations in check. Very few EHR solutions have any likelihood of 100% charting adoption. Some have proven track-records of charting adoption, but usually using voice-recognition software - as a keyboard or mouse intensive process is extremely likely to slow the doctor down. Expectations of transcription elimination should be contrasted against several reference sites provided by the EHR Company. Be wary of any referrals that indicate that they have no problems. Expect even the best solutions to have only 90% to 95% of charting done in the EHR on-time.

EHR systems can provide excellent cost savings and increase clinical staff productivity. However, they can be an expensive gamble if you cannot find a long-term solution. Beyond having realistic expectations, be sure to do your homework. Here are seven suggested methods for finding an EHR system for your practice:

1. Create a short list. Make sure you have at least 3 and at most 6 vendors that have electronic health record systems built for your specialty. Narrow your list down to a final 3 before you make a decision.

2. Call your colleagues. See what your friends are using in their practice. If you have other doctors in your medical specialty that are using EHR, check their pulse. If satisfied, add their vendor to your short list.

3. Research the Trade Show. Most likely, if the vendor has success in your medical specialty, they will exhibit at your specialty trade show. Check them out at the show, and note the competition. Add the best exhibitors’ solutions to your short list.

4. Check the references. Not only should you demand at least 3 references in your specialty, but you should check these carefully. Try to create a standardized list of questions for the reference phone call, similar to what you would do if you interview a job candidate. Creative questions that pull out pain points are critical. Be realistic about the answers.

5. Research the company. One of the big problems in the early days of EHR adoption was the startup company. Just like the "dot-coms", many were started in basements and didn’t survive. Make sure your company has been in the EHR business for a long time (not just PM) and has stable financial backing. Visit their headquarters if necessary. As an example, the old Medical Manager software for practice management has been around for 30 years. They have a new EHR component has been around for a couple of years. Ownership has changed about 10 times in 5 years. Look beyond the 30 years, and decide if this is stable enough for you. Other companies have been in the EHR business for over 10 years.

6. Industry certifications. Look beyond the hype. Most certifications don’t actually survey use of the software. They simply look at features or technology and give it a stamp of approval. If over 100 software products have received CCHIT certification, but only 80 are still in business, it CCHIT the only thing that matters? Check for specialty certifications, and promote functionality above features.

7. Implement slowly. One of the failure reasons for early EHR adopters is the lack of data in the system. Forcing a doctor to use the charting solution, without having the data in the EHR is a perfect recipe for disaster. Choose to adopt a document management or scanning solution first, and then adopt some clinical features such as electronic prescriptions or electronic lab results. Once the staff and doctors are comfortable, upgrade to the full EHR and push charting electronically to save on transcription costs. Find a vendor that will help guide you along this transition process. Don’t however, let momentum go stagnant. Resistance to change is natural. If you let this resistance occur time and time again, it will win. Force the change, but implement change with foresight and planning.

Don’t get caught up on hype. Choosing the right EHR solution for your practice is one of the most important decisions you can ever make. The benefits are real, but only if you choose wisely and have realistic expectations. There are probably only 5-10 solutions that will work for your specific practice. Use the steps above to avoid the other 300 companies.

Electronic Health Records
Electronic Health Records