I’ve heard this mentioned a few times, but in all my posts I don’t think I’d ever mentioned it myself. But it’s very true that EMR is the Physician equivalent of an ERP (Enterprise Resource Planning). Wikipedia describes an ERP as such:
Enterprise resource planning (ERP) is an integrated computer-based system used to manage internal and external resources including tangible assets, financial resources, materials, and human resources. It is a software architecture whose purpose is to facilitate the flow of information between all business functions inside the boundaries of the organization and manage the connections to outside stakeholders. Built on a centralized database and normally utilizing a common computing platform, ERP systems consolidate all business operations into a uniform and enterprise wide system environment.
Basically, it’s consolidating all of your IT software in one package. However, the real key is that by implementing this broad variety of packages you’re affecting almost every part of the organization. This is why I think the comparison of EMR software with an ERP is so interesting. An EMR has the same impact on the entire organization as the ERP does in a business.
As an aside, it is also interesting to note that ERP’s have been slow to be implemented in small business and have been most popular in very large companies. So, I think it’s interesting to see that we’ve seen a somewhat similar thing happen in healthcare. Most large hospital organizations have an EMR (at least in some state) and the smaller clinics have been more resistant to implementing an EMR.
The question then is what are the lessons we can learn from ERP implementations that we can apply to EMR implementations? Turns out that they’re things that I’ve talked about over and over.
1. Get Leadership Buy-In – An ERP is doomed to failure without a strong leadership that drives the ERP initiative. Since it affects every level of the organization it takes a strong leader to implement the changes and bring everyone together. The same is true for EMR.
2. Find Great Support – When you implement an ERP, you have to create a huge budget for customizations. In fact, one of your biggest expenses will be the consulting help you need to customize the ERP to meet your organization goals and policies. The consultants you bring to help you are critical to the quality of the implementation. EMR and IT consultants can have the same impact during an EMR implementation. Every EMR needs some level of customization for your clinic and a consultant well versed in your product can be a great boon.
3. Consider Implementation Phases – An ERP never goes live all at once. They ALWAYS do it in phases. This could be a great lesson for EMR implementations. Don’t bite off more than you can chew when you’re implementing. For example, in one implementation I did we just started with entering the diagnosis and charges into the EMR. Then, shortly after that we implemented the rest of the charting in the EMR. You can’t implement EVERY EMR feature from day one. So, phased EMR implementations are a good idea.
4. Include Staff in Selection Process – I was working at a large university and was asked to participate in a presentation by each of the ERP vendors. I felt very empowered to be part of the selection process. The challenge is that you can’t be fake about this. Don’t invite people to the meeting and then not listen to them. Otherwise, it will have the opposite impact from what you want. Really listen to people’s feedback and make sure they know you heard what they said and took it into serious consideration. Turns out that this involvement also helps with the buy-in mentioned above.
I’m sure there are many more. Feel free to add some in the comments. Much can be learned from other industries that can be applied nicely in healthcare. We’re not as unique as we’d like to think we are.
Thank you John. Your comparison is on target. Coming from the ERP world where a MYSAP for small business costs only $20K and the implmentation costs $80K on an average……………. and averages 60 to 90 days, implementing it in phases through all the departments and business units and finally the management is able to see consolidated view of the performance of the company in crisp dash boards, the financial, performance, efficiency metrics available in one click of a button as opposed to going thru’ various spread sheets for couple of days. Yes, I hear you and agree with you.
And more importantly, training all the constituents on the importance of structured data and why it is important – so that when the query is done, the right data is pulled and data integrity is maintained…..
Unfortunately, ERP training cannot be completed during a coffee break!!!!!!!!! Its a bit more than that………
EHR with all the required functionality built in, if implemented, trained and operated right, has many benefits to Providers, Patients, vendors and Payers. Buy-in has to be there from all participants, especially the Providers and their decision makers.
And finally, related to your anology of ERP, yes 90s saw the Enterprises implementing ERP, followed by Mid-Market in early 00s and Small Biz in the later half of 2000s.
More similarity is the Supply Chain Management Systems that were embraced by Enterprises and having understood that Supply Chain Management Systems will not make sense if the small business supplier does not implement the same system, forced the small businss suppliers to Implement such systems so that the information exchange is real time to enable efficiencies to be achieved………….
Cheers
Anthony Subbiah
ERP and EMR NOT the same!
In Canada EMR means: Electronic Medical Record which means it consists of patient records for which the physician has a responsibility and under privacy law permission to use to the benefit of the patient. While the patient health records may be the core of the physician’s business they are not primarily financial, human resources or about other assets. Just as the hospital has a health records department holding THEIR core records about services delivered on behalf of patients and also has financial, managment, marketing, administration, billing, accounts payable systems which altogether feed into an ERP, the physician’s office has those as well – but the EMR – the Patient’s medical record is the patient’s health record. Law and standards require the designation of Purpose of Use for EHR and EMR records, the primary one being Care. While it may be permissable for a physician, in a protected environment to use the records he holds on behalf of patients for other ethical or permitted purposes, the purposes are not so wide open as to be considered part of an EMR.
To suggest that an EMR is analagous to an ERP is also to suggest data ownership. In countries which apply internationally accepted Fair Information Principles the concept of ownership has little application to patient records. rather the physician is a steward of the information – the patien is the owner.
Correction:
While it may be permissable for a physician, in a protected environment to use the records he holds on behalf of patients for other ethical or permitted purposes, the purposes are not so wide open as to be considered part of an “EMR” – Should read:
“the purposes are not so wide open as to be considered part of an “ERP”!
elaine,
The way the information is shared might not be the same as an ERP. Obviously, there’s different laws for health information. Although, financial laws are pretty intense too. However, my comparison was the organizational impact of implementing an EMR is similar to the impact of implementing an ERP. There’s a lot of similarities since it is used by so many areas of a clinic similar to how an ERP impacts many business areas.
What is similar between an EMR and ERP solution is the dependence upon various point products that need to be used to support the mission. No single vendor can supply all the parts. For instance, a coding engine, pharmacy benefits manager all are bolt-ons usually in an EMR. Likewise, an ERP solution needs supply chain collaboration and order fulfillment to plug into the ERP engine. At one time, I saw over 25 major components to Oracle’s former 11i Business Suite, some that were purchased and then bolted on.
Lastly, an ERP solution doesn’t make sense for smaller organizations, but an EMR makes sense for all sizes, big or small.
IN essence, it’s the wrong argument to say that ERP = EMR. More likely, the struggle to install a major product is still a struggle and requires top down buy in as well as bottom up involvement. Without either, the project will be less than optimal in results.
EMR = Physician ERP? I think you are overbuilding …
Is this what physicians and administrators have told you they want in recent posts? I don’t think so.
I think I must have done a bad job on framing this post. Or people seem to have gotten far too caught up in the title and missed the content of the post. The point of comparing the ERP to the EMR is to find lessons that can be taken from ERP implementations and applied to the EMR world. It’s not about the academic exercise of defining terms. I’m far too practical to deal with defining terms. I’m about the ways we can learn to improve EMR implementation. I think one of those ways is looking at what works in an ERP implementation and applying that to an EMR.
Certainly they’re different beasts, but that’s often where the most learning can come from.
John,
I agree that there are similarities. I have no doubt of that.
By the way. I had a chance to talk to the CIO of one the country’s largest HMO and I asked him about ERP in their environment. Interesting answer.
That’s why there is so much “charge” on ERP vs EMR in the health care world.
From a project management standpoint, there is no doubt that similar paradigms have to be employed for success. I agree completely and I apologize if I am perceived as criticizing. It was not my intent.
Richard,
It’s not you or anyone in particular. I just thought it was important to move the discussion beyond semantics to the real point of the post and the value in the analogy (at least my hope).
I’d be interested to hear the CIO’s answer to your question.
Semantics aside, an EHR implmentation, like it or not, tocuhes all aspects of a small, medium or large practice. And the implementation, project management and training does require efforts similar to the efforts spent in an ERP implmentation; and similar to ERP, if & only if, all the constituents use and maintain the integrity of data, the benefits of EHR can be achieved.
During implementation cycle, the Physician may chose to continue to use paper and later an administrative assistant may input in the system. Ultimately if the Physician does not do this by self, and relies on Admin Staff to input at a later time, he/she is not using the Clinical Decision Suppot Systems in an EHR.
Like ERP requires the businesses to take time to maintain the integrity of data entered, so also is the EHR. Cheers