Most of the practices that we advise and that are using some form of EHR are struggling to make their adoption successful. The struggles range from the minor troubles such as workflow disruptions and input irritations that drive staff nuts, to the “what have we done to ourselves” sentiment. There is a common theme among these practices, and that is that every one of them made major missteps key areas of the project before the first piece of software was ever installed. They were not adequately prepared, and as one physician recently shared with me, his practice has been “harmed” by their EHR efforts.

To be fair to all sides, there is plenty of blame to go around in these struggles; practices often times don’t understand the enormity of inertia required to make the transition successful. As a result they do very little to in the planning phase. Throw in aggressive EHR vendors into the mix, whose sole purpose is to convince you as to why they are the best choice, and you have a recipe for disaster. Decision makers in the practice often rely too much on these sales people for objective guidance, and often times end up making their decision based on their feelings for the sales people, rather than what is best for their practice.

The problem with this approach is that it often results in a practice that doesn’t understand the long-term effort that is going to be required to make the implementation successful, and therefore is not prepared to move forward. In any EHR implementation, planning is the single most important phase. Good planning can make sub-par EHR software work well (and there are plenty of sub-par applications out there) and no planning can make the best EHR software a miserable failure.

You can never over-plan your EHR adoption, but under-planning is always a constant threat.

I sometimes get criticized for being too discouraging of EHR adoption, and that certainly is not my intent. Anyone that knows me knows that I understand very well the tremendous benefits of a practice EHR system, and how those benefits can transform a practice in a positive way. What I do discourage is a poor adoption strategy. Poor adoption strategies can do a lot of harm to a practice and will cause substantial setbacks. Physicians and their staff work too hard to provide the best care for their patients to be misled about the challenges that their EHR is going present.

The standard advice that I give when talking to physicians and practice leaders is to slow down. Don’t allow yourself to get caught up in the frenzy of EHR’s without first giving it serious consideration and careful thinking. If you feel like you are being passed up by all the other practices out there and are tempted to put the pedal to the metal, resist the temptation. There is still plenty of time to begin the process, to develop a solid plan for evaluating, selecting, implementing and supporting the implementation for your practice.

The integration of an EHR into your practice is an important step that can pay some hefty dividends when it is done right. Take your time, be careful and deliberate in your planning and seriously getting outside, objective help in the process. By following this simple advice you can avoid doing harm to your practice.

Mark Bebout

http://www.softworksco.com/

Most other industries are already there: financial, communications, and entertainment to name a few. Hospitals are way ahead of private practice physicians with their digital initiatives. All documentation about our patient’s hospitalization, from lab results to discharge summaries, must be printed out on paper to be included in their medical record in the office. All information sitting in the chart in the office is inaccessible to the Emergency Room doctors who see the patient presenting at night or on the weekends. We know this to be true. Traditional paper-based medical records can impede delivery of excellent medical care.

Doctors are resisting the change to EMRs, however, because there are currently just as many problems with the computer “solutions” proposed to be the panacea of all problems paper.

Patient data still needs to be input. Different medical charting systems don’t sync easily with others; a standard for data sharing between all hospitals and doctors’ offices is lacking. A private practice will need ready access to IT support, just like what’s available at most hospitals so patient care can continue when the system goes down. This change is going to require monumental energy, time, money and other resources. These are assets that most doctors have in limited supply now as they struggle to keep up with their current workload.

If the government and insurance companies and the fear of losing money can’t motivate doctors to update their practice methodology, then their patients will most likely force the change. Patients will go to doctors keeping up with the times. They will seek doctors able to communicate with them like they communicate with their family and friends, and who have systems established to help them get what they need easily, efficiently and accurately. Doctors need to know about the social web, iPhone applications, Facebook and Twitter and begin to think how these technologies will someday fit in their practice. My mother won’t be one of those patients, but I know my children will be. Read the article, “Doctor of the Future” in the May 2009 issue of Fast Company magazine for some real-life examples of medicine tomorrow happening right now, today. Whether we doctors like it or not, the future is upon us. Time to get with the program! RB

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P.S. In case you need some more information about Twitter, here’s a recent Twitter how-to article published on the MSN website on February 9, 2009: Getting Started with Twitter.