The Path to Paperless

Why Some EMR Projects Fail

Take steps to prevent these "failure factors."

By Peter J. Polack, MD, FACS

Depending on the source, the failure rate of EMR implementation reportedly ranges from about 30% to 50%. Part of the difficulty in calculating failure rates is determining the difference between a true failure (often reported by a software vendor) and an abandonment, where the practice simply stops using what could be considered a 'working' EMR system.

Regardless of whether it is considered a true failure or abandonment, the end result is the same: Lots of time, money and heartache and a practice that is back to using paper charts exclusively. The causes can be broken down into several major areas:

Lack of purpose. Many EMR projects are essentially doomed from the beginning. Without having specific goals for the system, there is little chance for a coherent game plan. Unclear objectives and unrealistic expectations will further decrease chances for success. Practices without a clear understanding of their situation often fail to get the expert advice that could have avoided much grief in the first place.

If you don't know what you want, you can fall in love with a particular software system without properly vetting the product or the company. And as we've seen in previous columns, this should be the last step in your EMR implementation process.

Problems due to change management. Experts in project management cite 'people' problems as a major cause of project failure. And EMR is no different. Younger physicians and employees have grown up around technology and will hardly miss a beat. But physicians and employees in their late 40s or older may have more of an adjustment. Their resistance may manifest in subtle ways, ranging from withdrawal to overtly refusing to use the EMR system.

Adequate training of these individuals should be accomplished well in advance of go-live day. Without the proper training (and retraining) aimed at putting critical new skills in place, your practice will lack the critical mass of staff buy-in needed for a successful implementation on the go-live day.

Lack of leadership or commitment. Do you have a physician champion? A champion may not make all the doctors enthusiastic about EMR, but that isn't necessary. You just need them to buy into the project. The practice champion should also make sure that the lines of communication are always open. Hold regularly scheduled meetings both before and after your practice's EMR golive date so the system can be debugged before a user gets discouraged and gives up.

Poor technical planning and implementation. This covers the gamut of issues from hardware and software to the setup and rollout of the entire system. It is advisable to have either IT staff on board or a reputable outsourced technology firm or consultant involved in both the planning and the implementation phases.

Proper technical planning can also help ensure that there is a proper 'fit' between the practice needs and the EMR solution. This can mitigate such failure factors as unrealistic expectations regarding the time it will take to get the EMR working properly, loss of productivity in the clinic and inadequate customization. All of these can lead to abandonment of the software system and result in a perpetual search for the 'perfect' EMR solution, which is unfortunately never realized. OM

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Peter J. Polack, MD, FACS, is co-managing partner for Ocala Eye, a multisubspecialty ophthalmology practice located in Ocala, Fla. He is also founder of Emedikon, an online practice management resource for physicians and administrators.