I’m often amazed at how many people underestimate the impact that an EHR implementation will affect a practice. Actually, maybe far too many people understand this and that’s why EHR adoption is so low. What worries me is that so many of those people that do implement an EHR completely underestimate the impact that an EHR will have on their practice.

Let me try and make the case about how important an EHR is to a clinical practice. I do this not to try and discourage people from implementing. Instead, I do this to encourage people to take the EHR selection and implementation process more seriously. The decisions you make in regards to which EHR you choose will have lasting impacts on your clinical practice.

Let’s take a look at why this is the case. An EHR is part of EVERYTHING you’ll do in a clinical practice. I can’t think of one part of a practice that isn’t directly affected by an EHR (I’m assuming it’s an EHR and PMS). Everything from how you move patients through the clinic to how you handle phone calls will be impacted by your choice in EHR.

Your EHR will become the center of your universe. This is true for the front desk staff, the nurses, the business office and the doctors. No one really goes unaffected except maybe the janitor, but they’re probably a contract worker anyway.

The reality is that you’re going to spend more time working in your EHR than you do with patients. Yes, that does sound wrong to say. It feels wrong to even type it here, but it’s the reality. However, don’t think that this is something new. You could have previously said that you spend more time doing paper charts than you actually spent with patients. Until we go back to the Little House on the Prairie days with one doctor who didn’t document anything, this will be life as we know it.

Now, doctors shouldn’t think that this situation is all that unique. Technology people often end up spending more time doing paperwork, policies and procedures, proposals etc than they do actually working on tech. I’m sure there’s 100 other examples of similar situations. Of course, the point really is that you’re going to spend a lot of time on your EHR. If you’re going to be spending so much time on the EHR, then it seems like the EHR selection and implementation decisions should not be made lightly.

Ok, still don’t believe me that an EHR is the core of a clinical practice? Think about this.

If EHR isn’t the core of the operation, then why do clinics run so slowly when an EHR is implemented? They run slow, because it is the heart of the clinic.

If EHR isn’t the core of the operation, then why do clinics literally shut down when they can’t connect to their EHR?
They shut down, because it is the heart of the clinic.

I’ve definitely said my fair share of things about CCHIT. Sometimes I wonder what CCHIT thinks about my comments. I’m really not trying to be mean, hurtful or ugly about it all. I just want to share my own feelings about the certification and educate people as much as possible about what the CCHIT certification can and can’t do. It’s not my fault if I just find a lot more wrong with it than I find right with it. At the end of the day, I try to follow the advice of a radio personality don’t try to please everyone. Just try to be right.

The good thing for me on this blog is that when I’m wrong, people correct me in the comments. I always reserve the right to change my mind and make updates as are appropriate to make me right again.

However, relatively recently someone made a comment that kind of insinuated that I might have something to gain or lose based on CCHIT’s success or failure.

Let me clear this up once and for all. CCHIT’s success or failure won’t affect me and my work at all. The only exception might be that if CCHIT sticks around, then I’ll have plenty of content to write about on this blog for as long as they exist (rim shot).

Seriously though, I really have no ties to CCHIT certification and specifically whether or not it becomes the certification criteria for the HITECH act or not. In my day job we actually use a CCHIT certified EMR that is highly focused on our niche, college health. In this job, we don’t accept Medicare or Medicaid and so honestly the stimulus means nothing to us. We’re not going to get any EHR stimulus money so why would we care which certification criteria is selected? We don’t.

Even more interesting to consider is the following. I mostly work with 2 EMR implementations right now. One is my day job and the other I do because the wife (and also office manager) of the Dr. is so sweet that I feel like if I don’t help them she’ll suffer. What can I say, I’m a bit of a softy when it comes to REALLY nice people suffering. Probably more than you wanted to know, but those are the 2 I rather actively work on.

The cool part for both of those implementation is that they are each fully implemented with an EMR and they are very happy using an EMR regardless of EHR stimulus money. In fact, both of them made the decision to implement an EMR years ago and are very happy with the decision. In the doctor’s case, any EHR stimulus money he can get will just be like a bonus. However, regardless of whether he gets money or not, he’s very happy to have an EMR.

Basically my point is that I have no financial interest in the success or failure of CCHIT and in particular whether CCHIT becomes the certification criteria or not. It basically won’t affect my life. So, when I make comments about CCHIT, it’s purely out of my interest to educate people on the subject. I guess deep down I also hope that some of the things I write and share will make a difference in someone’s life. I guess time will tell if this is the case or not.

A recent comment asked me what I thought about this person becoming essentially an EMR selection consultant. I started to reply in the comment, but it got so long that I decided that it was worthy of it’s own post. Plus, then all the EMR and HIPAA readers can provide other counsel and advice in the comments which will probably be even more valuable than what I have to offer.

Considering so many people are losing jobs and searching for new emr jobs (no, I wasn’t paid for that link, but I was paid for the EMR Jobs ad on this page), I think this post is timely. So, the follow is my advice to Jim about becoming an EMR selection consultant.

Jim,
I think there are a lot of doctors that could use this type of service. There are 4 things I think our worth mentioning to you.

1. Are doctors going to be willing to pay much for this type of service? It’s certainly a valuable service, but do doctors see this as necessary and worthwhile or do they think they can just do it on their own using some certification or recommendations from friends, organizations, associations, etc. In these economic times, don’t be surprised if many of them aren’t ready to spend money on this either.

2. Why should doctors trust you with this decision? I’m not speaking of you specifically since I don’t know you. My point is that this is a HUGE decision by a doctor. How will you make the doctors feel enough trust in you to have them help you make the decision? Once you earn their trust, it’s gold.

3. Many doctors are just browsing for EMR software. Be sure that whatever contract you create with the doctor, it’s clearly specified what your responsibilities are and what the doctors responsibilities are as well. They’ll HAVE to play a major part in the selection process. However, you don’t want to be stuck ready to go through the process and they’re not willing to commit the time. Then, you’ve wasted your time and won’t get paid. Also, don’t fall in the trap that they have to select the EMR for you to get paid. Otherwise, the doctors will just spin their wheels on the decision making and you won’t get paid for much longer than you planned.

4. Be very clear about any conflict of interests you may have. Try to avoid having conflict of interests at all. However, it’s sometimes too nice to not get paid a referral from an EMR vendor when you’re the one that sent them the business. You’ll have to work that through yourself. However, I ethically believe if you are getting paid to help someone select an EMR, they should be made fully aware of any conflict of interests you may have in your pocket. Now, if we could just get our government leaders to do the same (but I digress).

I know there are many other things, but I hope this helps. I really think there’s going to be a lot of work in the area of EMR selection for a while to come.