Challenges of EHR Adoption

Satisfaction with EHR implementations has dropped over the past two years, and new implementations are slowing according to recent study by American EHR.[1] One big problem highlighted by this study is reduced productivity due to the lacking usability. Think about ease of use for a moment.

Every day over one billion people visit Facebook through their computers, cell phones, tablets, or other electronic devices. Why? Facebook is a fairly simply interface. Even if they change the some of the basic elements every few months, the interface is intuitive and easy to learn. Aging adults are rapidly adopting Facebook to interact with family and friends.

Let me be quick to point that EHR adoption obviously has regulatory compliance challenges alongside the particular challenges of each medical practice, but these challenges are not insurmountable obstacles to usability. For several years, Even Steele has been writing and discussing the challenges of EHR adoption. In a recent HIT Consultant post, Steele says that he actually predicted this drop on EHR satisfaction several years back because many practices were failing the due diligence.

They didn’t properly look at questions of usability and how the new EHR interface would impact workflow, productivity and efficiency issues. Once the practices adopted the new EHR interfaces, they noticed a drop in productivity. In the recent study, physicians and nurses found new workflows to be more cumbersome and time-consuming. To combat this disappointing impact, Steele has previously suggested that healthcare facilities must take greater control of the EHR vetting process to make sure that issues like usability, productivity and efficiency remain at the forefront.

Steele says that, “physicians are left blissfully unaware of the historic failure rate of each of the EMRs they are considering.” The adoption committee must play a more active role in the evaluating potential vendors. Here are some suggestions that Steele thinks committees should consider: [2]

  • Invite (i.e., require) vendors to participate in a side-by-side comparison test, which will allow you to benchmark the number of clicks it takes to accomplish the most common practice workflow tasks. Focus on the 20% of the tasks that make up 80% of a typical physician and office staff workflow—reviewing specific chart information before seeing a patient, signing off on a message, reviewing labs, or generating a prescription, for example. The other fancy features touted by EMRs are irrelevant to productivity. Clicks are time, and time is money, so this analysis will provide a true measure of relative efficiency and opportunity for increased revenue and profit generation.
  • Use real patients with typical clinical presentations, or simulated patients of your design—not the standard patient used in the vendor’s demo. This information will be directly relevant to your physicians and will demonstrate how usable and flexible each EMR is for you.
  • Ask for the names of 20 clients of your practice’s specialty and size who have recently purchased and implemented each vendor’s EMR. This will give a better idea of the vendor’s depth of experience with your type of physicians. Don’t rely on the vendor’s references—do your own networking and research. This is the only way to uncover the not-so-successful implementations in addition to the well-marketed successes.
  • When negotiating contracts, ensure that the physicians are protected on the down side—insist on having the option to be refunded the entire purchase price of the software if physicians do not adopt it. This will demonstrate the vendor‘s confidence (or lack or confidence) in their product and will ensure that you will get the highest level of implementation services and support. You must protect yourself from vendors who are anticipating a crush of orders stemming from the Stimulus Plan and who will send green employees to manage your implementation, thereby reducing your chances of success.

[1] Alan Brookstone, MD. “HIMSS13 — EHR Satisfaction Diminishing.” AmercianEHR, March 6, 2013 <http://www.americanehr.com/blog/2013/03/himss13-ehr-satisfaction-diminishing/>
[2] Evan Steele. “How to Avoid the Sting of a Bad EMR Choice.” EMR Straight Talk, September 23, 2009 <http://blog.srssoft.com/2009/09/how-to-avoid-the-sting-of-a-bad-emr-choice/>

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