Recently I met with some colleagues: physicians practicing Neurology & Family Practice, both of whom haven’t yet gone to EMR. There are two main reasons for this:
1) They’re not sure where to begin. Several of their friends have tried unsuccessfully to implement EMR at the practice. In most cases, it was a strong effort; some teams gave up as time went on, and others went down for the count. Some lost money and time on the project, then calling for ‘no more.’
2) The rate of failure among electronic medical records projects is estimated at between 30 and 50 percent. At first I was startled at this high rate. But, asking around you’ll find someone who’s had a bad experience, or someone who has. It’s difficult to calculate a true failure rate, especially when determining the difference between abandonment – a stopping of use with the EMR system, or true failure – often reported by a software vendor.
Regardless of whether a situation is called an abandonment or a ‘true’ failure, there is the same result: Money, time, heartache, and a practice which falls back into using charts on paper exclusively.
The primary causes fall into a few major areas:
Lack of Commitment or Leadership
Is there a champion physician at your practice? Physician groups need to reach consensus and keep things moving, and without this the smallest bump can have serious repercussions. The champion need not become an enthusiastic proponent of EMR, but they must buy in with the project. Once a staff starts to sense a lack of unity among the level above, things may begin to break down, with splits into different camps, either pro- or anti- EMR.
Ultimately, if the project fails, the entire team fails – not just the single person who initially championed the cause. There’s the chance of a mutiny spreading among the group. There could be a single physician or staff member who is purposefully thwarting the project. They could be spreading doubt among the neutral, or attempting to escalate problem situations. The champion must discover and re-organize these influences before they travel too far into the organization. The champion also must be sure that communication lines are working, with scheduled meetings before and following a date to go live, so a system can quickly be set straight before a particular user gets frustrated and gives up.
Bad Planning & Implementation
This category covers the entire gamut, from hardware and software issues, to setup design, and on to roll-out implementation. Either an IT staff person should be on-board, or an outsourced technology consulting firm should be involved in both planning and implementation. This could include planning, planning training, as well as the product design, and implementation stages. A dynamic schedule or another work breakdown structure should be in place, to keep things on track. A simulation day is another true test. Together these components nurture success, especially in a crisis. Expect to have at least one.
The Internet Technology advisor is also able to assist with network hardware purchases, while trying to control the overall costs of the system. Of course, that doesn’t recommend buying the cheap stuff, either. Controlling the costs of physical infrastructure can turn on you in the end. Unless your office is small, consumer equipment available in retail stores may not be advisable. Obtain and keep up with service and maintenance agreements, including backup switchers and servers. Failure to do so could reduce your practice’s effort.
Having no Purpose
Some electronic medical records projects are in trouble from the very beginning. If the goals for the future system are not described or understood, the chances that a successful plan can form is low. Unrealistic expectations and unclear objectives further reduce the chances of success. Often, practices which don’t maintain a clear understanding of the situation or fail to get expert help could have avoided the problem of no purpose. What do you want the EMR system to do? If you’re not sure of what you ultimately want, you won’t be able to understand what the EMR system needs. If you’re swept up into some software system at a meeting at the Academy, but without understanding the product or company first.
Change Management Problems
Ask any expert dealing with implementation of major technology projects. No matter which industry or business area, they all talk about the ‘people factor’ as being a top cause of project failure. Electronic medical records isn’t any different. Many new doctors have grown with technology, having even trained with institutions already using an EMR system. They won’t skip a beat. The same is true of younger staff members accustomed to social networking and texting. But some of the older physicians make have to make a greater adjustment. They may even have only recently using the Internet, or suffer from technophobia. The resistance to technology can appear in many ways, including refusal and withdrawal. Providing proper training for these employees, preferably by their co-workers, is key in preventing a learning curve that is too steep to be accomplished in advance of the day to go live.
Some of the older staff members could need substantial training. A process should identify those who are falling behind, requiring more re-training. Your practice can’t afford to lack critical buy-in from staff or a lack of ready skill that’s necessary to implement a project successfully.
Workflow processes are also involved in change management. Inefficiencies in care of patients will only be exacerbated on a digital platform. The go-live date is not the date to discover that the new EMR system doesn’t live up to the way they’ve always done it before. Proper technical planning can also help ensure there is proper ‘fit’ between the practice needs and the EMR solution. This can mitigate such failure factors as unrealistic expectations about the time it will take to get the EMR working properly, loss of productivity in the clinic, and inadequate customization. All of these can lead to abandonment of the software system and in a perpetual search for the ‘perfect’ EMR solution which is never realized.
By the way, do you want to learn more about implementing EMR in your own practice? Download my free report “Getting Through The EMR Maze.”