A reader recently sent me a couple personal stories about EHR implementations that I thought worth sharing. I’m not going to say that these are the typical implementations, but I will say that I’ve heard stories like this far too often to ignore. I’ve removed any identifying information about the people, practice or EHR company. This really isn’t about one company, because you could insert any number of names and get the same story. Also, excuse any bad grammar since they didn’t intend it to be posted here, but have given me permission to post it.
Thanks to the reader who sent it to me.
Son-in-law is a family medicine practitioner in a 5 doc group. Wife is a CFNP MSN in an EP Cardiology group. Both here in [CITY REMOVED]. Spouse’s group elected [EHR Vendor] about 2 years ago… at last count of the 12 cardiologists in the group… only 2 were still on board with the program. At least half the problems they have may be due to their unqualified IT plumber who can’t keep their servers running … and when running only at half speed. Typically, they bought the basic package with minor training … someone in their sales contingent also convinced the owning docs that their nurse clinicians could do all the local programming needs … although warned them that if the nurses broke the code … it was their fault. As a result the nurses will not touch anything. [EHR Vendor] (and the local architecture) can’t keep pace with their clinic schedules… wife and the 2 remaining docs who use the EHR spend hours at night and on the weekend doing their record updates because there is no way to do it during the clinic day.
Son-in-law’s group which is owned indirectly via [COMPANY NAME REMOVED] by the [REMOVED] Health System also picked [SAME EHR VENDOR] without consulting any of the docs at any location anywhere in [STATE REMOVED]. His group… one of the biggest revenue wise in the system was chosen as first by the [COMPANY NAME] brains for implementation. Training was provided by 1 [COMPANY NAME] administrator to the ~5 or so admin and business staff … as they were only implementing the business end of the EHR … not the patient record subsystem at this time. On day one… the 5 docs saw a total of 4 patients the first 4 hours they were Hot. With typically 6 patients an hour scheduled … times 5 docs … equals 30 per hour total x 4 hours … equals 120 patients … so 4/120 isn’t even on the chart for failure. They had dozens of patients walk out. Docs were all sitting idle in their offices … and the [COMPANY NAME] administrator and their site manager were pissed at the docs … but the docs just shrugged and said… “we’re here… where are the patients?”. Problem of course was up front where none of the records and pt data was loaded ahead of time so it was like they were all in a brand new practice.
I’ll just let you chew on this one for a little while.
This does sound like a typical problem with a poor implementation. There are so many points of failure in this story. Unfortunately, I see that doctors are mostly the ones who are the major decision makers and I don’t think they should be. I was fortunate to have been hired to specifically implement an EMR and upgrade a practice management system and was pretty much given carte blanch in terms of authority. However, because I have the experience to know that I do not know everything about everything, I worked with my doctors and got their opinions, concerns, suggestions and wishlist but in the end, they went with the recommendations and plans I made to them. We ARE successful now and continue to improve every day but our story could have easily turned out like the one above. I recently was asked to do a demo for another practice like ours. This was as a favor to a salesperson because our specialty does not have a lot of prebuilt content. I prepared for that demo the same way I would have prepared for one in my own department. I hadn’t been speaking 2 minutes, when one of the docs interrupted me and said “let’s get on with it” and again 2 minutes later “so who do you work for again and what is your connection with these people” and again in the presentation he stopped me and said “I want to see you take a patient from start to finish from the time they come in until they are billed” — I explained to him why I couldn’t do that on a webex but he was relentless saying my presentation was bascially worthless if I couldn’t show him that. The sales rep stopped the presentation at that point. In reality, the doctor missed the entire point of the demo and possibly what an EMR could actually do for them by staying inside the parameters of his closed box. And as you have said in other posts, there are bad consultants recommended by bad companies so how is one to know? In many cases the doctors are not well informed and do not know that they are not so they end up like the “son-in-law” in the story above.
Ouch Cyndee, that Dr sounds like an ass.
Thanks for sharing Cyndee. A doctor like that is not even wasting time on. It takes give and take by everyone in the practice to make an EHR implementation work. I’m guessing that doctor never wanted an EHR and so they were just acting out to avoid having to implement an EHR.
[…] « Previous article Two Experiences with Failed EHR Implementations EMR Install Base – According to Vendors Next article […]
“I want to see you take a patient from start to finish from the time they come in until they are billed”
That is an excellent idea. A must see in any EMR demo. Even better would be for the doctor reviewing the EMR to be the patient and the Vendor has to record the visit. You’ll see how hard it is to document electronically.
DRM,
My firm has done a number of observations of actual “patient walk in the door and then back out the door” for a number of large EMR vendor systems. If they all worked well and the provider community embraced them and market penetration and satisfaction was anything more than about 10 or 20%, we would not bother entering the marketplace.
Just did a walkthrough a few days ago for one of THE leading ambulatory EMR systems. The proof is in the pudding.
Docs and nurses involved. Plenty of training, implementation stuff done, custom templates setup — you name it. The providers ain’t gonna sand bag. They want it to “work” whatever that phrase means to all parties involved.
Now I’m not being critical of HIT. Their hands have been tied by all kinds of factors. Until now.
DrM,
I’ve heard that suggestion as well. I especially like for the doctor to be a normal patient who asks about multiple problems and adds in the oh yeah problem after the visit is almost done.
John,
Yes, that’s what we hear and see also. One little thing presented out of the norm or expected.
Our last live clinical observation session was just a few days ago. Simple setting, RNC seeing teenage kids for back to school sports exams. The kids need the OK to play sports.
Provider was thoroughly trained in the EMR, (a claimed market leader), as well as a number of others, comfortable with computers, plenty of time during the visit and plenty of time between appts, all pat demographics already in, templates already setup, a custom template already setup for sports physical, AND this provider had designed her own template for this type of encounter.
Not only could the charting not be done in the magical timeframe, but the provider believed it could not be done properly and professionally in almost any reasonable timeframe. Even basic capitalization, punctuation, grammar were missing or wrong.
Lastly, the provider was not at all confident that the ARRA/HITECH structured data was being captured in a meaningful way — accurately, completely or meaningfully. In short, in a useful way.
Now, take the above slam-dunk, and add your wrinkle — patient presents the “and oh yeah” one other thing.
Stories like this are the reason I do what I do for free