Why Do Good EMRs Go Bad and Sometimes Ugly?

posted Apr 8, 2010, 11:45 PM by Poly A Endrasik Jr   [ updated Jun 23, 2010, 7:28 AM ]
             We can all understand the basics of what makes a bad EMR bad, they could be poorly implemented template designs / strategies, multiple screens to record the same information. . . to mention a few. Generalizing, it can happen when a product is developed by software designers with little interfacing / testing with real practicing doctors! Enough said!


              But what makes a good EMR go bad? The cases where you read numerous conflicting stories from “it’s the best product since sliced bread to this product was a disaster of epic proportions! So, why do we see this big difference? Let me give you a hint, it is not always the cost of the software. Research has been showing us that it could be due to any number of factors or combinations of. Probably the most common and actually will encompass most of reported individual factors is poor project management. Defining all the requirements, thorough and accurate accessing the current practices, determining the risks / mitigation strategies, developing a project plan and maintaining communication with all that are involved / affected are key underlying elements, if not executed properly, that can derail a good EMR. Simple isn’t it? Sounds like common sense you say? But it isn’t always that simple or common!


              Let’s take a few examples; an efficient ASP-based EMR goes bad when using an over- utilized internet connection. Now, it’s not that it doesn’t work or it was demonstrated to work fast “during off hours” when the product was installed / tested but the fact is it “now” doesn’t keep pace with the doctor / practice during normal business hours!


             What about a doctor that really wants to commit to using an EMR but simply can’t type fast enough to keep pace with the old way or typing interferes with the quality face time with their patients. How should this risk be mitigated?


Although I really could go on and on, lets give one more example because I did say “a few”. What about all those paper/film patient medical records you still need to refer back to? Was scanning, with search capability, presented as an EMR implementation strategy / service? Would that help prove “meaningful use”?  


              Yes, you are probably thinking the devil is in the details and you are right! An EMR implementation is simply not loading the software, setting yourself and staff down to some training and away you go. A successful efficient EMR implementation should be considered a project and be properly managed. Especially if you are a solo / small practice and your margins are tight. Research indicates most doctors really want to focus on providing quality care to their patients rather than become well versed in IT / project management / training. . .!


              Hmmm, when you look at a IT project management, it’s much like practicing medicine. The doctor studies and trains for years to become proficient in determining the health goals with your patients, analyze their condition (may require lab work / stress testing. . .), document their lifestyle and determine a defined management / communication plan for their success! I must say I really appreciate and value the fact that they do this day after day, patient after patient because that’s what is in their heart and they have the talents to do.


             Oh, almost forgot, what makes a good EMR go ugly? When patient files are left on a laptop, hard drive, memory stick, server. . . that are unsecured and/or not backed up and are lost, stolen or compromised. That’s ugly for both doctor and their patients!!!