Docs describe EMR experiences

Highlights of our survey results regarding EMR usage and implementation include:

• Like last year, EMR adoption is higher than many experts and observers have predicted, but interest may be waning somewhat. About 35 percent of our survey respondents said they already have a fully implemented EMR, while another 40 percent are in some stage of shopping, purchasing, or implementing one, or they are using an EMR provided by an affiliated hospital. About one in four respondents still insist they’re not interested in the technology. Last year, 41 percent of respondents were already using EMRs, and only one in five said they were uninterested.
  
  
• Of those practices in the market for an EMR, most expect the selection process to go quickly. A full 77 percent of respondents shopping for an EMR expect to make their choice within six months (or they report that that’s how long it took them to select the EMR they’re using). Only 12 percent expect their purchasing decision to take longer than one year.
  
  
  
  
• Many of the practices that have already purchased EMRs found their implementation process to be surprisingly quick. Fifty-eight percent of respondents said it took only about a month to implement their EMRs, up from 49 percent last year. Only 17 percent said, “We’re not there yet,” compared with the 23 percent who were struggling with implementation issues last year.
  
  
  
  
• Many EMR-enabled practices recognize the technology’s financial impact. For example, about half of the responding practices reduced staffing levels as a result of acquiring an EMR (up from 42 percent last year), and 88 percent agree that, overall, their EMR has streamlined their workflow.
  
  
  
  
• On the other hand, we were surprised to learn that only 40 percent of practices said they expected to see any ROI, and only 28 percent said they’d earned back in efficiency more than they’d spent on overhead. Daniel Lazar, for example, says that for all the benefits of his practice’s EMR, it is “really hard to measure” whether it’s had an overall positive affect on his practice’s bottom line. With interest in EMRs surprisingly high, and expectations of ROI surprisingly tepid, it appears that many practices are prioritizing advantages other than financial benefits as their motivating factor for purchasing the technology.
  
  
  
  

Not always a bed of roses

We heard lots of EMR stories with happy endings. But physicians are not technology Pollyannas. While largely optimistic, many also declared themselves nervous about the costs of EMRs, worried about implementation issues, and skeptical of potential technology partners.



We heard cautionary tales about fly-by-night vendors and companies that don’t clarify the fine print in their contracts.

Lawrence Pasik, MD, in West Bloomfield, Mich., told us the EMR provider his practice chose seemed financially sound until its checks — payments for a data-sharing program — began bouncing: “The company is either out of business or close to it. They had only five employees the last time we contacted them,” down from 200, Pasik reports. “We have moved on to another medical records program, but there are problems.”

Johnny Chang of Avon, Conn., says his EMR “actually made for more paperwork, not less” within his practice. Karen Pryce, the administrator of a practice in Ashboro, N.C., describes “the upfront and unexpected costs associated with preparing to implement an EMR” as a “nightmare.” She adds that the “IT knowledge deficit within our office made it very difficult to understand terms, conditions, and other issues of the EMR negotiation process.” And surgeon Robert Feher of West Hills, Calif., wants an EMR but is worried about “cost, privacy, and typing input with [the] patient in the room.”

Many of you registered complaints about common technologies other than EMRs. Connie Merrell, the administrator of a surgical group in Boise, Idaho, says her practice recently added voice recognition software because “we felt we needed to make some move into the 21st century, and we’re not ready for an EMR yet.” Voice recognition seemed like a nice first step for the two-physician group, says Merrell.

But results have been mixed. One of the physicians likes the system more than the other. The technology itself works well enough, Merrell explains, “when we use it properly. If the doctor speaks clearly, it picks it up pretty well, but sometimes when they’re tired, they mumble.”

Ultimately, the cost of the vendor’s technical support rather than the technology itself has Merrell the most upset. She says she was surprised to discover that the vendor they chose charges a flat quarterly service fee of $1,070, regardless of how often the practice needs help. “We don’t call very often — maybe once every three months — but if you don’t pay, they won’t service you at all,” she says. Merrell wants to cut ties with the company, which she says didn’t fully explain its service charge before the contract was signed, but the practice isn’t yet confident enough in independently using the new technology to risk going forward without any support. “I am so disappointed by this that I will look forward to going to an EMR in the future and telling this company we no longer need them,” Merrell says.

But the vast majority of complaints we received came not from practices uneasy about technology in general, but rather from those disappointed by the results of their good-faith efforts to boost efficiency through technology, usually because they picked a vendor that was more intent on making a sale than on providing service. Indeed, we heard very little of the “Who needs technology?” attitude that some believe is typical of physician practices.