The Path to Paperless

Practices Mainly to Blame for EHR Failures

Usually, failure is a result of a poorly planned implementation.

By Peter J. Polack, MD, FACS

If you comb through the blogosphere on the topic of electronic health records, you may find a surprising amount of negative commentary. And if you mention the financial incentives for meaningful use implementation, things get downright testy: anti-government sentiment, conspiracy theories and a call to resist the temptation to go paperless.

These critics of the federal mandate to implement EHR cite studies that show that EHR has failed to improve practice efficiencies or control costs. They point to usually vaguely documented practice horror stories centering on what they see as high failure rates leading to many doctors losing money. But why all the controversy now?

A New Category of EHR Adopters

I think what we are currently experiencing is the high middle of the market adoption curve of these systems. There are many “early adopter” practices that have been successfully using EHR for years, but now we are starting to see the more conservative and skeptical practitioners jump into the game, with very mixed results. We get reports of failed implementations and abandonment, multiple purchases leading to significant write-offs, or incomplete implementations that are barely limping along. The culprit, according to these unfortunate practices, conveniently, is the software itself.

Illustrator: Mark Heine/Deborah Wolfe, Ltd

But the high failure rate of EHR system implementation (30-50% in most studies) is not so much a reflection of the technology as a lack of knowledge of basic change management by physicians. We don't learn anything about business in medical school and we certainly don't learn how to integrate complex technologies such as EHR into a small business. But it is a people-management issue, not a tool-management one.

Misplaced Blame

I disagree that EHR systems are by definition inefficient and that they don't improve productivity. We have not found this to be the case in our own practice after 3.5 years of EHR use and we have only begun to realize its full potential. What most practices don't realize is that it is just part of an overall sea change in the way you practice medicine. Even the best EHR system cannot fix poor workflow processes. If anything, it will make them more obvious. Our EHR implementation was planned for three years before we went live and the software wasn't chosen until halfway through this process. Most doctors buy the first EHR they fall in love with and then make their administrator try to implement it in three months. This is like buying a new tool and then trying to figure out how to use it.

Some feel that the financial incentives from the government, with complicity on the part of insurance companies, will ultimately prove to be a clever way of controlling physicians through the lens of promoting “better” healthcare delivery. And true, any time that the government and private carriers agree on something, you have to pause and think. Rather than having to cull through stacks of paper charts, auditors can now make you upload your entire file set for their bots to search through.

But EHR systems are here to stay. Electronic practice management systems replaced paper schedulers and pegboard ledger books. Paper medical records will soon be a thing of the past. Physicians can resist and be dragged kicking and screaming into the 21st century, or they can become educated and informed, perform their due diligence and realize that this will be the most expensive and difficult thing they will have to do in their career — maybe besides raising their kids. OM

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.