May 5, 2010
EMR Implementation in Small and Large Clinics
Written by: John
I always love to hear clinics talk about the challenges they face in implementing an EMR. For the most part, they are completely predictable. Especially when it comes to the small versus large clinic challenges.
For example, small clinics will complain that they don’t have the resources that large clinics have to implement an EMR. Large clinics will complain that they have too much bureaucracy, red tape and stakeholders that they have to get on board an EMR implementation. They wish they were like smaller clinics who could quickly make decisions and had a much more focused need.
Of course, the reality is that both of these point of views are accurate. It’s not news that small clinics can make decisions easier and that larger clinics have more resources at their disposal. Certainly a generalization, but the reason it’s a generalization is because it’s generally true.
Since both small clinics and large clinics both face major challenges of resources and red tape respectively, then how does any clinic get over them and implement an EMR? Let’s be honest, it’s really more a matter of the priority EMR is given than anything else. So far many doctors offices haven’t decided to make their EMR implementation a priority. Once a clinic makes EMR a priority, it’s really quite amazing to see what happens.
The good news is that for many clinics, the EMR stimulus money has changed this fact and bumped EMR adoption up on their priority list. Plus, in the 4+ years I’ve been writing about EMR software, EMR software has come a really long way. Sure, they still have a ways to go, but the EMR software of today is much improved and can provide some real value to a clinic if implemented correctly.
It’s time to address the excuses for why you can’t do an EMR and start focusing on the benefits you can receive from an EMR. Notice I didn’t say “ignore” or “hide” the excuses. We need to address the excuses people are giving and see what benefits you might be missing because you’re not using an EMR. I know very very few people who use an EMR and would ever want to go back to paper. There’s a reason for this.
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3 responses to "EMR Implementation in Small and Large Clinics"
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Talking about small clinics and budget makes me think of these two news stories about people generously helping African HIT get started (here and here). Just goes to show you don’t need huge resources or stimulus funds to get started.
I just finished a three part series on reasons for adopting an EHR; my last post included resources to help providers evaluate what’s on the market, which unfortunately was a pathetically limited list. I posted links to your book and the wiki, hopefully someone may go and add to it. I’d love to get feedback from any other tools I may have missed that can help people make these decisions.
John, I’m grateful for your reasoned and moderate tone when discussing EMR adoption, but your bias does seep through. For example, many clinics aren’t giving “excuses”–rather, they are giving sound reasons for not implementing an EMR. I’ve used 7 different EMRs in 3 states, and in every case we would have been more efficient and productive with paper. This is mainly because I work in high volume emergency medicine, where EMR has been shown to reduce productivity by 20-30%, and where leaving the bedside to log in for CPOE leads to delays in treatment, longer wait times, and increased error rates. Instead of focusing on how to get doctors to use EMR, a consultant should focus on how to get an EMR to work for doctors.
Brian,
I’m certainly bias towards technology. I’ve just seen so many instances where technology has had an amazing impact for good. I also think we agree that if you don’t have buy in from your clinic (everyone involved), then there’s no reason to proceed with an EMR either. From what I’ve seen, most of the reasons people offer for not implementing an EMR are not reasons, but excuses for why they just don’t want to change.
As I said above, I’m not saying to ignore these concerns. They’re important to address so that people will be bought in to the EMR implementation process.
And yes, on occasion there are instances where technology is not the right solution. Or at least EMR isn’t the right solution. I’m good with that. There were a number of times in my discussions with users that we tried to force things into an EMR, and we quickly realized that we were trying to force a square peg into a round hole. Doesn’t make sense. I’m all about using whatever is most efficient (technology or otherwise).
So, yes, maybe the current EMR technologies aren’t efficient in a high volume emergency medicine situation. However, I know of at least one quickcare (not sure if that’s different than what you mean) who couldn’t imagine documenting the huge volume of visits they do without the EMR they use. Of course, this is why I say that choosing the right EMR for your clinic is so important. The wrong EMR can be a disaster. The right EMR can be amazing.