Seven Reasons Why Medical Practices Have Yet to Adopt EMRs

It is no secret. The majority of office-based physicians are not using EMR’s. According a recent article in FierceEMR only 6 percent are using a fully functioning EMR. I’ve read in other places adoption is as high as 15%. Still minuscule in the grand scheme of things.

Why is that? Why the slow adoption? Is it because docs fear technology? Is it because doc’s prefer the antiquated method of analog documentation? Is it because they see not added value in EMR’s?

In many circles, doc’s are criticized for their slow adoption. However, I’m going out on a limb here and suggest it is the fault of [most] EMR vendors that doctors have not fully adopted EMR’s in their practice.

Here is why:

1)      Too expensive: EMR’s have been around for at least 15 years, yet EMR vendors have yet to achieve economies of scale that reduce the price of EMR’s.

Imagine if a small business owner had to pay $6,000 or $12,000 for each license of Microsoft Office; how many small business owners would install MS Office at that price? A stripped consumer version of Adobe Photoshop runs for less than $100. A full version runs for less than $1000. I understand EMR’s are complex pieces of software, but does it really have to be that expensive?

EMR’s are so expensive that even the government realized  doctors’ adoption of EMR’s on their own merits was not feasible, so they will soon be offering up to $45,000 per physician to cover the cost. What does that tell you when the government has to step in?

2)      No Dominate Players: There are so many EMR vendors out there that it isn’t even funny. Deciding on which one is the best value for a practice is very difficult. Using the MS Office metaphor again, imagine having 20 or 30 different types of office productivity suites application to chose from, how would that affect the decision making process especially when one considers the wide range of options, prices, support that each one of these EMR vendors offers? Which brings me to my third reason…

3)       Too Many Choices: I’m all for choice, but when there are so many [unproven] companies out there, deciding on one is very overwhelming. It is like trying to choose a new breakfast cereal in the grocery store isle. There are so many cereal choices, one ends up sticking with the one you’ve been eating since you were a little kid.

4)      Locked in: Once a practice decides on a system, they are locked in due to the large investment. If the practice doesn’t like the system, if support stinks, if upgrades are few and far between (you know who you are), there is nothing a practice can do about it. Unfortunately, all the money to pay for the software is provided upfront; therefore walking out if things go sour is simply not a realistic option. This too is a hard pill to swallow for physicians.

5)      No Interoperability: Our EMR, despite being touted with all this HL7 compatibility stuff, doesn’t speak (computer language that is) with any other EMR on the planet (I can’t even send an electronic file to a doc with the same EMR software. I have to print it out for them, and they would have to scan it in). Thus, the efficiencies one would gain from being able to retrieve data from multiple area hospitals or other health care facilities and medical offices are non-existent. Imagine having one of those 3 and 1 machines (fax, copier, scanner), where the fax function doesn’t work because it can’t send or receive messages from any other fax on the planet.

6)      Productivity claims are misleading: EMR vendors love to sell the notion to doctors that with their EMR, they can see more patients and spend more time with their families. This is a little misleading. The fact is a doc can complete a paper chart, with their chicken scratch, faster then they can clicking and typing thru an EMR program.

EMR’s can enhance productivity (it can also hinder it as well), but not the way most EMR vendors plug it. For our practice, the core productivity enhancements are:

1. Saves time tracking patient data
2. Helps organize, automate and synchronize patient encounters
3. Enhance physician documentation

Our EMR helps us be more organized, thus we are more productive. But the EMR (at least in our experience) doesn’t help doc’s work faster, thus be more productive. There is a distinction there.

7)      Too complicated in their design: One can tell by looking at [most] EMR’s, that an engineer designed it. What does that mean? The user interfaces looks like an old cockpit of a plane. There are so many buttons, it is hard to know where to look at first.

Doc’s are smart people, so they eventually figure it out if they have the motivation. But just like the rest of us, they like cool, sleek simple design too. As a little known designer said once, “simplicity is the ultimate sophistication.”EMR user interface have to improve in order to gain more adoption. Design matters!

UPDATE: I decided to post one more reason as a bonus point.

8)        Implementation is a pain:  About 2-month in of implementing our EMR, I called our EMR’s sales rep and told him to come get his software because we didn’t want it anymore. The implementation of the software was so overwhelming, so tedious, so backwards and so difficult that we thought we had made the wrong choice.

As it turned out, pretty much everybody I’ve come across that has adopted an EMR has had similar experience. We weren’t the only one. In our case, the EMR vendor did a poor job of managing our expectation, training was terrible and as a result, expectations did not meet reality.

When others hear these horror stories from people that have gone through the process, who would want to go through with something like this? That is why implementation has to improve in order to get more people to adopt EMR’s.

Do you agree? I’m sure there are EMR vendors out there that would disagree with me. Let me hear what your thoughts are.

For 11 more reasons why medical practices have yet to adopt EMR’s, check this link out here