Are EHRs Being Oversold?

I am a firm believer in the tremendous value that the right EHR can deliver to physicians, so the historic dissatisfaction with the EHR industry—as reported in studies and anecdotal conversations—has long disturbed me. The alarming intensity of this dissatisfaction was brought home by visitors to my company’s booth during the recent AAO (American Academy of Ophthalmology) meeting.

I was truly appalled by the abject frustration and anger expressed by numerous physicians about their EHRs. One visitor described his experience by saying, “It has taken the joy out of practicing medicine.” Another said that he felt like he should put a picture of his face on the back of his head so that his patients could see him—because he was forced to focus on the computer and enter data while the patient provided information. Physicians universally complained about the “productivity-killing” impact.

From AAO - Are EHRs Being Oversold?Why is this so? I know there are good EHR products in the market that physicians enjoy using and that enhance, rather than reduce, their productivity. Why are physicians not more successful in finding these?

The answer is that EHRs are being oversold. There are many EHRs that are marvels of software, capable of doing incredible things, but the selection process that physicians typically employ is flawed, and the sales process capitalizes on this shortcoming. The salesperson dazzles them with a demo, or they take prospective purchasers to see a physician—typically just one or two—who adeptly uses the software. This creates a false sense of ease-of-use, and the physician prospect leaves the site visit expecting that he or she will be able to use the EHR just as successfully. But not all physicians are alike—they may all be very intelligent and have tremendous medical expertise, but they are not all equal in technological inclination or skills. Their success—or lack thereof—with a particular EHR will vary significantly.

This brings us back to the importance of doing due diligence—something I have talked about before. Call and/or visit a variety of physicians who represent a wide spectrum of proficiency. Go to the reference practice’s website and select physicians on your own—don’t rely on the vendor’s selection. Ask the kind of questions listed in the last EMR Straight Talk. This is the only way to increase the odds of a successful EHR experience, and to avoid making a painful and costly mistake.

14 thoughts on “Are EHRs Being Oversold?

  1. You have a major stake in this but I will provide the following comments. EMRs were introduced by a RAND corporation paper based upon computer modeling paid for by major players in this field who stood to make serious money from EMR introduction. No clinical trials were ever conducted. The Bush administration people, corporation worshippers, believed without independent study that the touted $81 billion savings would be realized. They therefore pushed forward the universal adoption of EMRs with the penalties and incentives we are familiar with.

    Problems: 1)The systems are derived from business software by business software programmers. The assumption, usually correct in the business world is that data is discrete, easily adaptable to a spreadsheet and easily compilable. Medical data is fuzzy, personal and hard to compile in this manner. 2) The programs are user unfriendly in the extreme, cumbersome and inflexible. The learning curve is seriously long and even when mastered takes a terrific amount of time away from the patient.3.) There are way too many players, none of whom will share their programs so they cannot “speak” to each other. Remote data access is therefore usually not possible (and this was one of the highly recommended aspects of EMRs).

    Advantages: 1) Billing is rapid and comprehensive (of course these are business models and one would expect this portion to be terrific). This is not a saving for the government or insurance who relied upon the previously sloppy billing to miss things and diminish payout. 2.) Access to radiologic and laboratory data within one system is rapid and very useful 3) Electronic pharmacologic prescriptions are specific and less subject to error (although pharmacists used to catch these).
    Global Problems: The industry is in rapid flux, with buy outs and meaningless competition. The result for the physician consumer is that todays program may be obsolete tomorrow and buy outs are usually to eliminate the competition, not to adopt their systems that work (Sorry, we no longer support your $40K system but you can buy ours at a bargain rate of $38K this week only). Training is lengthy, expensive and markedly disruptive in an office. Hardware and software will have to be regularly updated at significant expense. The incentive payments will not cover this cost and the cost for a small office is prohibitive.

    What should have been done? (Too late unfortunately). The government could have asked for clinical practical trials to determine the value to be derived. Note that all studies to date have not shown any benefit in patient care and safety. The best solution: The government already owns two pretty good EMRs – the VA system and the military. They should have put these out for public evaluation and improvement by industry programmers, develop a comprehensive program based upon the best of these, and then buy it from that vendor and give it away for free to all takes This would have saved a tremendous amount of money, provided a national comprehensive system, and allow for easy improvement and modification.

  2. As an early adopter of an EMR, I was excited about the prospect of increased efficiency, accuracy and productivity provided by an appropriate EMR. Our initial experience with the system demonstrated that the excitement was justified. Our documentation accuracy and speed increased. There was a net savings to the practice. Now, however, the EMR is functioning more and more as a reporting tool for CMS and other insurers. We are losing all of the efficiency gains as we interact with an increasingly cumbersome system. I now requre a scribe to maintain the patient flow that was seen four years ago when we began using the system. I am appalled that the potential benefit of these systems is being lost on the increased regulatory function that they are serving. If these systems are going to continue to function both as charts and reporting tools, then developers of the systems would be well advised to create systems that will handle both functions smoothly, accurately and efficiently. I am unaware of any of my colleagues who have such an EMR.

  3. I’ve used a scanning system for the past 14 years now. I hand write my notes, and scan them. Works great, and speeds up my office. Doesn’t do reporting. Doesn’t bill. Just let’s me have all my patient files at my fingertips, and access them at home, on my ipad, iphone, or wherever, as they are all in pdf format.

    Unfortunately, doesn’t meet the criteria that will allow me any incentive payments, but changing will cost me more in efficiency than any incentive payment will make up for. Most of what’s out there is just too clunky.

  4. I’ve often wondered if it would have been possible for the Academy to develop our own Ophthalmology EMR module that would incorporate the unique approach that our specialty uses to record a visit. Then make it available to all vendors. We could then have a common format and maybe, with luck, each be able to modify it in ways that would satisfy our need to master our craft. For me the joy-killer was encountering the endless barriers to putting my own ideas to work.

  5. The trouble with most EMRs are the horrible UIs that are designed by committees who have no concept of ease of use for ophthalmologists. They just often pile features on top of one another in obscure menus, ribbons and popup alerts forcing the user to spend so much time clicking on button after button hunting for what they actually need to do. Instead of being simple and easy to figure out as soon as you turn it on, ophthalmologists are forced to attend seminars and spend more money on training courses for the software that they purchased. Steve Jobs was right about the need for simplicity and leaving out features that IT guys may love but make the software unusable by the masses.

  6. Don’t those stories just make you sick? I agree that part of the major problem has to do with physician’s EHR selection process. I’m not really blaming them, cause selecting the right EMR is not easy. However, many could be spared the major pains they experience if they spent more time selecting the right EMR.

    As you probably know, I think the EMR selection process is so important I wrote an e-Book to help doctors with the process: The nice part is that I made it free in an effort to really try and help doctors.

  7. The author suggests due diligence. A nice concept, but it requires shutting down one’s practice for numerous days to see demos; or to visit other users. I attended a session on EHR selection at the 2010 AAO meeting. The presenters were from a large practice in the Southeast. The administrator of the practice was lawyer with tremendous business experience; they had a full time IT person. The lawyer was probably getting paid more than I am. We have a medium sized practice, 4 MDs, 2 ODs, 3 offices, and we can not afford to hire a lawyer to run our practice, or to hire a full time IT person. We did fairly thorough due diligence, we think, and decided to get Nextgen. It is pricey and complicated. We have just begun the 6 month process of implementation. It will probably be 12-24 months before we know if we made a good decision. The AAO could help by not being so vague about these products. How about an AAO analysis, a la Consumer Reports, that ranks the EHRs, shows their prices, and selects “Best Buys”, etc. That type of service by our national organization would be invaluable.

  8. I agree with Mandes Cates.It would be helpful if the AAO could advise us about really useful and reliable EHR’s that are relatively from commercial bias and the usual El Toro excreta.

  9. I agree with most of what has already been said. We are a year into implementation and it has been horrible and costly. What little efficiencies gained have been lost to a decrease in productivity and worse by increased cost due to software fees and fees to the IT company. We are a practice of 3 MDs in 1 main office and 4 OD satellites. It has been terrible working with companies that have limited experience and support. And when something isn’t working or they are inefficient we have to pay.

    I believe I am paying for them to learn their jobs! And it doesn’t get better! We need someone like the AAO to sort through this industry and tell us what are the better products. We do not have the time or resources to sort it out and the people we get the info from cannot once again have any financial benefit in the product!! The company I have been dealing with tells me I need scribes but I thought EHR was supposed to make it easier so I don’t need to increase my staff! This has been a crazy process.

  10. Unfortunately, at this point the risks outweigh the benefits. In our dreams these systems will be on a unified platform thta will enable both sharing and transfer of information as it should. We are still at the stage where the left hand does not speak to the left. Other than saving space, this is all for naught.

    Regarding the incentive, nice carrot to dangle, however, the ongoing and future costs of updating, maintainence, etc will out strip any incentive. Should Congress run short of $$$, your incentive will either evaporate or be retroactively rescinded just like the current Medicare “take back” of the Jan-May 2010.

    Sad scenario at best.

  11. The gov’t could have saved billions by writing a software EMR program and giving it away. All practices could then talk to each other and we would not need to worry about having an EMR that’s is not compliant. Also, who protects us if the EMR vendor goes out of business or decides to double or triple support fees? I like having a physical entity like a chart to hold on to. That way I do not need to depend on others for the very essence of my practice.

  12. Most of the practices I meet stuggling with EMR implamentations have been sold a training process that is almost do it your self. Some practices get a train the trainer model or web training. The idea, anyone can deploy an application, responsable for automatiing the entire process of delivering medical care, through web training or even train the trainer is the true problem. Although systems might be easy to use they are never easy to build or learn.

    This is the key. Practices need to invest in training and not fall prey to vendors claiming they can build out the system through web training or train the trainer. Practices need to evaluate how the vendor will guide them throght a system build and go-live and invest. This will lead to a useful EMR

  13. Sam is right that there is sometimes limited training resources available for the EMR adopters and thus it takes away from productivity. Some software vendors offer webinars, but many times this is not enough training for doctors using an EMR for the very first time.

    It is very important that the practice puts due diligence in consideration for the training, so they can utilize the software to it’s potential.

    Tons of EMR vendors out there. The smart ones have already become ONC-ATCB certified.

Comments are closed.