"However, when the sale was made and implementation began, the honeymoon was over. The first indication that things might not run smoothly was the arrival of two large boxes containing mountains of technically challenging software and manuals that I, with a greater than average knowledge of IT, couldn’t even understand. Sometime later, the experienced technician that was to load the software didn’t arrive. Rather, a local IT person loaded the software with the experienced technician on the phone giving directions. After loading, the software didn’t work as described. My questions to the vendor were answered by ‘you need more software to do that.’"

But far more common are success stories. One physician bragged about "efficient and complete documentation, accurate billing and coding, letters by fax to referring physicians on the same day, savings in cost … ."

Another physician wrote, "We are almost completely paperless after one year, and I would never go back. We are better organized. Our office is neater. We never lose a chart. We are connected to both our lab and our hospital so retrieving results is easy. We need at least one-third less people to work in our office … It has been a work in progress, frustrating at times, but also exciting and fulfilling. It has been paying off in a big way financially."

Clearly, it’s crucial to do as much homework as possible before your purchase. Test software yourself using a case typical for your practice instead of just watching a slick demo. Ask specific questions about how the implementation is done and seek contractual promises of satisfaction.

Many complaints were aimed at products that coupled a less-than-stellar, afterthought practice management program with an EMR. Practices found documentation went fine, but bills weren’t getting out the door. The billing components of the management software just weren’t up to the task. Integration with existing management software also seems sticky. It’s buyer beware. Full integration isn’t easy because so much medical software products (especially older practice management systems) were built using proprietary coding. A lot of that coding is quirky. It’s not so easy to make it mesh with a newer, proprietary EMR system. If a vendor promises it can integrate with your existing software, great. Just ask for very specific details and proof that it will work.

What about the tendency of EMRs to push administrative work onto physicians? Some of you made it clear there’s good reason for concern. Take this, for instance: "Physicians and clinical staffers have taken on more clerical responsibility since we’ve gone ‘paperless’ because it’s ‘just one click’ to submit the prescription to the pharmacy yourself or fax the notes to the consultant from inside the program. All the ‘one more clicks’ add up to minutes which, over the course of the year, represent decreased productivity.

"We’re not looking for charts anymore, but we’ve replaced this activity with clerical clicks. We used to pull charts, attach paper clip messages, confirm appointments, check for results in the chart, and file. All those things [now] happen through technology. Now, we have to ‘live message’ into the patient’s chart. The typing, writing and communication skills are completely different."

Still, those who managed to get through implementation generally were pleased with their decision to move ahead.

More than 80 percent of you who have an EMR say it made your practice’s workflow more efficient; almost as many say you’re getting a return on investment or expect to. Forty-two percent of you reduced staffing thanks to your EMR while only 8 percent said you needed more.

The investment is still a big one. While prices have dropped and become more consistent since the early days of EMRs, vendors tell us it can take as little as $1,000 or as much as $30,000 to get a two-physician office up and running. On the other hand, 40 percent of you who bought an EMR spent less than $500 per physician.

That’s no surprise. It’s possible many of you bought economy class tickets for your maiden voyage on the EMR bandwagon. Also, let’s face it, when first purchasing a new technology, too many features can be a little scary. "We were not interested in bells and whistles," wrote one respondent. "We simply wanted the easiest system, with the quickest ROI. It had to be an ASP so we had minimal hardware headaches. That means that locum tenens easily learn the system. Every month, the system pays for itself."

Messy management

One downside of the EMR boom is that it may have encouraged practices to ignore their practice management systems — the backbone of any physician office. One in three of you admit your practice management software is at least five years old, and some of you are using systems more than a decade old.

Yet you don’t much like the management software you’ve been using all these years. Two out of three of said you wish your system did more. Better reporting and better integration topped the list of needs.

"It can often be difficult to figure out how to get what we want," writes one physician. We need "more flexible reports, without having to create a customized report, both the equations to select and manipulate data, and the page layout tool to format the output."