STOP! In the Name of EMR Success

September 18, 2008

Ten years ago, when I gave talks to physicians about electronic medical records, I would get little response other than quizzical looks as to why a doctor would be so excited about computers.

Ten years ago, when I gave talks to physicians about electronic medical records, I would get little response other than quizzical looks as to why a doctor would be so excited about computers.

These days, EMR adoption has entered the mainstream. My judgment within my own practice is no longer viewed as suspect; now, it’s visionary. Still, our practice is not seen by outsiders as one succeeding financially because of adopting EMR technology. We are successful despite such adoption.

EMR adoption continues to be regarded as risky, and not without cause. Many physicians’ offices have tried it only to see overhead inflate, income deflate, and frustration levels shoot through the roof.

Why does one office succeed in integrating EMR while another fails? The answer lies in a single word: implementation. How a practice effects the transition from paper to electronic charts is a bigger determiner of success than the actual choice of EMR.

Think of EMR adoption as akin to rebuilding an airplane while it is flying. Somehow you need to continue to pay your bills and generate revenue while you change the very foundation of your business -- not easy. So how do you stack the odds in your favor?

  • Understand the task. Many see EMR adoption as simply changing to an electronic version of the paper chart. It’s so much more than this. Staffers at all levels of a medical practice -- administrative, clerical, and clinical -- need a clear understanding of where the practice is moving to and exactly how things will change, especially in terms of work flow.

  • Get help. The culture of doctors not trusting others’ opinions greatly hinders this. But EMR adoption is different from practicing medicine. There is no reason to re-invent the wheel. Others (including me) have made many avoidable mistakes, had they just tapped into someone else’s expertise. It’s an ego thing.

  • Plan, plan, plan. Once you comprehend the enormous -- yet worthwhile -- nature of the task, it becomes clear that this is not a simple transition. Take time to understand how each step of the process affects each area in the office. The lifeblood of a medical practice is the throughput of patients, and this can get hung up in many places. A team approach is extremely important in keeping the right pace. Indeed, more mistakes are made by changing too much at once rather than taking a step-wise approach.

  • Seek out champions in unexpected places. Yes, you need to have some who are the visionaries in each area. These should not necessarily be the most tech-savvy. Many tech-minded people don’t understand the business aspects of things, but the business aspect is what pays the bills. Find people who can see how change in one place impacts the other areas of the office.

  • Honor your naysayers. Don’t worry if some of the physicians and/or staff are reluctant. Every office will have a “loyal opposition.” Skeptics should not be dismissed; instead, address their objections. Sometimes these balkers make valid points -- points you might be glossing over in your unbridled enthusiasm for EMR.

Obviously, much help should come from your vendor, and much of your choice in vendor should be based on its implementation process. (Stay tuned: more on this in future columns.) Still, the best product with the best vendor can’t overcome the naïve or negative cultures endemic in some offices. So before you go off half-cocked buying the first EMR you investigate, establish a solid foundation for implementation to ensure success.

Robert Lamberts, MD, is a primary care physician with Evans Medical Group in Evans, Ga. He is board certified in internal medicine and pediatrics, and specializes in the care of adults, pediatrics, diabetes, high blood pressure, asthma, preventative medicine, attention deficit disorder, and emotional/behavior disorders. Dr. Lamberts serves on multiple committees at several national organizations for the promotion of computerized health records, for which he is a recognized national speaker. He can be reached at