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FROM THE CHIEF MEDICAL EDITOR

EHR: A Cautionary Tale

Larry E. Patterson, MD

Two years ago, I expressed my reservations about electronic health records (EHR) in this column. Last year, I reported that after exhaustive research, I finally bit the bullet and purchased a system. Now “live” for only six weeks, I'd like to share with you some initial impressions and warnings.

1. It will take you more time to “go live” than you think. Experts say it takes 18 months, from start to finish, to “go live” with an EHR system. If you think, no way, it can't possibly take that long, you are wrong — very wrong. There will be more delays than you can imagine. Perhaps your old practice management software vendor isn't as cooperative as you'd hoped during the transition (yes, you know who you are), costing you more time than expected to write new code. Maybe there was some miscommunication between you and the EHR vendor over who was doing what (happens all the time). Please don't take this process down to the wire. Give yourself extra time. Missing a year or two of a “meaningful use” bonus isn't that big a deal.

2. It will cost you much more money than you think. There are costly surprises hidden in EHR implementation. For example, some diagnostic machines may not be compatible with your new system, requiring you to write new code, purchase new interfaces, or even acquire new machines altogether.

Plus, expect to suffer a severe drop in cash flow while transitioning. My first day's schedule amounted to 25% of my normal workload, and that was almost more than I personally could bear. I ramped up to 50% by the second week. Now, after six weeks, I'm close to 80%-90%. In the meantime, we are paying more overtime than ever to get charts backfilled and just to keep our heads above water. The government incentive comes nowhere near compensating you for the true actual costs of implementing EHR.

3. It will be the hardest thing you've ever done in your professional life. If you are slightly older than me, do you remember transitioning from ECCE to phaco? Child's play in comparison. You have to approach patients and work in a way that is completely foreign to how you've always worked. My first day, I came close to breaking down in tears. I wondered: How would I ever pay for the system with the schedule slowed down? Would I ever adjust and get back close to normal speed? With my face glued to a computer screen during the entire exam, or so it seems, would patients ever see my face again? I'm grateful to my staff for not quitting, since I'd become somewhat difficult to work with. (Editorial note from my staff: He had become incredibly difficult to work with.)

The good news? After six weeks, it's getting better. The younger doctors are adapting fabulously, and we older ones are getting there. I'm happy with my vendor, especially since docs on other systems reported it took two to three years for them to return to their normal schedules. But I thought it was worth the warning that no matter what you expect of EHR, it will be worse, at least initially. And please, don't shoot the messenger… I'm already biting one bullet.