EHR Adoption Failure Is Not Always a Technology Failure

In one of the LinkedIn threads I was participating, Cameron Collette offered this really interesting insight:

Secondly, there is a general unwillingness to change current work flow models in many health care facilities. Daily I hear, “we have never done it that way” or “that’s not the way do things”. So, we have what is currently a greater than 40% EMR adoption failure rate. In other words, it is not always a technology failure. The technology might work, but in order to make it work properly requires a significant change in processes. Sometimes this would be a good thing. Sometimes it would not be a good thing as a lot of EMR/EHR designs were developed with virtually no real input from the people that have to work with them every day.

He’s absolutely right. It is very often the case that the problem with your EHR has nothing to do with the EHR technology at all. Often, one of the biggest problems that’s faced during an EHR implementation is a change to culture.

I’ve said multiple times that an EHR implementation requires change. I know that many EHR companies will try and sell you that their product can be implemented with no change to your workflow. That’s just an outright lie. Sure, some of them can do a pretty good job modeling your current workflow in the EHR, but there is still plenty of change that’s required.

Change and EHR implementation go together. Organizations that deny this reality have issues in their EHR implementation.

This is why every EHR implementation I’ve seen has required some powerful leadership that drives the initiative. It’s why the $36+ billion in stimulus money has driven EHR adoption so much. That money makes leaders respond.

My best advice for healthcare leaders out there is to embrace the change that EHR and other technology is bringing. You shouldn’t accept mediocrity in a tech system, but you should expect and be ready to change when you implement an EHR. In fact, one of the best assets you can build into your company is the ability to adapt to change.

5 years from now, I’m pretty sure we’re going to look back and think that the next 5 years of technology caused more change for good than we’ve seen in the last 10 years. If your organization doesn’t have a culture of adapting to change, they’re going to be left behind.

About the author

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

7 Comments

  • John, thank you for writing this up. This fact needs to be reinforced every so often. People forget the importance of three things for success in a business (and yes, a Medical Practice is a business) – People, Processes, and Tools. EMR is just a tool. Here is something I wrote related to modeling your practice –
    http://www.webbasedemr.com/home/2014/3/1/practice-model-and-practice

    I think with intense competition and pricing pressures at least in the ambulatory space, corners are cut and implementation is compromised. Blame must be shared between providers and vendors. Vendors should be willing to take a hard stand that unless someone pays for proper implementation, there will be a failure, there will be a breakdown and ultimately both practice and vendor suffer.

    Doctors need to realize that EMR / EHR software is just a tool, you can’t expect it to solve your problems by itself. They must ‘invest’ in proper implementation.

    Again, thanks for reinforcing and I do believe this is not the end of it, we need to keep on reminding everyone of the importance of implementation.

  • Sometimes the providers provide us with comic relief. For example, the doctor who refuses to use the correct log on (we have a room-specific log-on for the Citrix server and then a user-specific log-on for the EMR) which works well to prevent start-up delays for the dozen other providers but one cannot remember in which room she is. Another doctor insisted on using a form that was designed to renew prescriptions to issue new prescriptions and kept on insisting “but I WANT to use THIS form, I like it” when told that the vendor did not write it for new prescriptions. Then we have the department where the chair wants the forms in ABC order and all of the others want them in ACB order.

    When it comes to forms that I and my staff write, we have a bit form flexibility. As much as I hate to do so, I’ve cloned some of my forms and then modified them to meet the requirements of a few physicians. Of course, every time I make one change I have to consider applying it to each of the three other forms which once looked like quads and now only resemble each other.

    Should we complain? No! This keeps us employed and justifies our big bucks.

  • Every technology change I have made requires a workflow change. It is inevitable.

    But I find if I ask people what would make it easier for them, what they wish for, I get to how to implement technology rather than impose technology, and that increases buy-in by the end user in trenches.

    I’m going after hearts and minds….

  • I think the point has been missed.

    Medical processes need to be re-engineered.

    The processes created from thin air by EHR vendors with no input from practicing physicians are changes in process that disrupt medical care without being designed to optimize medical care delivery. Often they are a change for the worse. Seldom for the beter.

    The process change may be useful for some specialty out there somewhere(Almost by chance), but is likely not a good process change for the majority of specialties. The idea that a gynecologist and a pediatrician should use the same process is ludicrous. And yet we are being stuck with on size fits none EHRs.

    This is a tchnology failure in that the technology was not designed to improve the process of medical care. If you want me to change my process, show me how the process you have created is better. I have yet to be convinced.

  • P.S.

    The statement:
    Sometimes it would not be a good thing as a lot of EMR/EHR designs were developed with virtually no real input from the people that have to work with them every day.

    Is overly optimistic. It should state:

    USUALLY “it would not be a good thing as MOST of EMR/EHR designs were developed with virtually no real input from the people that have to work with them every day.”

  • I am not so sure I agree with the statement “a lot of EMR/EHR designs were developed with virtually no real input from the people that have to work with them every day.” My experience has been that these systems are designed with a specific workflow and technology in mind. However, what I see is that the healthcare industry is not only more complex than most others (e.g. banking) and that individual providing entities are so dissimilar that I am curious if the technology is not a disadvantage at times because it is not that good at adapting to the workflow quickly. What I am basically saying is that we all know that almost every provider is different with respect to workflow, and even though change can challenge some broken workflow systems for the better, why isn’t the technology being developed to quickly adapt to the workflow instead of the other way around? Just a little different paradigm!

  • Jack W,
    I think you articulate really well the challenge. There is very little standard workflow across clinics. They certainly resemble each other, but each have very different nuances. Dr. Hughes is right that it’s crazy that we apply the same workflow to an OB and a pediatrician. However, it’s also crazy that two OBs are so different. There needs to be a happy middle.

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