Common Myths About EMR

Common Myths About EMR
From the Perspective of a System Implementer

Much is being written regarding how ARRA incentives are the driving force behind EMR adoption. Despite this lucrative incentive, many physicians are still reluctant to adopt this technology. Some have heard horror stories from other physicians who have adopted, others just aren’t ready to embrace the technology, and even more just don’t have all the information necessary to make an informed decision.  With that in mind and based on my experience assisting clinicians and their staff in implementing this technology, I would like to tackle five common myths about EMR that should address some of those same physicians concerns.

Myth #1:  EMRs aren’t going to last
A good number of providers would like to dismiss EMR as just the latest fad to hit the medical world. They have seen numerous advancements in the medical field in both physical medicine and the technology behind it. They have seen how something as simple as penicillin completely changed the medical profession and how something as complex as early Practice Management software be hit and miss. There are providers that have worked in hospitals that have instituted an EMR program that had failed and was ultimately abandoned in full or scrapped for another program. This has left a bad taste in the mouths of those providers.  With the federal focus on money ($2B is not trivial, even by government standards), time (Congress is still engrossed in health care reform), and media attention (articles, news coverage, etc) on automating medical record keeping, EMR is here to stay. Every provider will have to make a decision on which program to go with in the near future.  There are a number of advantages to adopting EMRs, not the least of which is that having all of your patients’ information in one easy to access program allows providers to make better decisions when administering care. EMR can also be helpful when doing coding, which has reimbursement implications beyond ARRA incentive payments. Medicare currently pays bonuses to providers who do well with their Hierarchical Condition Categories coding, something that is much easier to track in an EMR system.  Other insurance companies will soon follow suit with pay-for-performance measures tied to healthcare reimbursement. Many hospitals have already begun to roll out plans in anticipation of this. It would be a great benefit for independent physicians and other providers to do the same and reap the rewards early.

Myth #2: The provider/patient relationship is negatively affected by EMR
There are a number of providers who are hesitant to adopt the technology because they feel they won’t give patients the attention that they deserve. Instead they think that they will be typing away and focused on the EMR screen rather than conversing with the patient and providing a thorough examination. The truth is that you can provide better care with EMR. With the click of a mouse you can pull up information about diabetes for example and show the patient on the screen and discuss a plan of action, even printing out instructions for them. You can generate diet plans based on age, weight, and health. That’s just to name a few. I have some personal anecdotes from my work implementing EMRs. One is a doctor who was reluctant to use his EMR system in the exam room. He decided to give it a try and asked me to be in the exam room with him with his first patient in case he felt lost. The patient at first wasn’t pleased that the doctor would be busy “typing away” instead of focusing on his concerns. However, with little assistance, he was able to successfully input the patient’s history, medications, and give a thorough exam. When the doctor showed the patient how everything was in his virtual ‘chart’ and how he would now be able to manage his care more efficiently, the patient was thrilled and the doctor was relieved.  There are many ways that providers can make the quality of care better for patients with an EMR while still giving them the care that they expect.

Myth #3: All EMR programs are the same
It is a common misperception that because EMR is discussed as a “program” that all EMRs are the same.  The truth is that each software program offers different options. For instance, just because one program allows you to create your own MS Word templates and drop them into a SOAP note, doesn’t mean that the next program will have the same setup. In fact most programs are not compatible with one another. So if you find yourself unhappy with your EMR program, chances are you will not be able to convert existing patient data to another one – at least not easily. Picking the right program the first time is important because of that. I have worked with many providers who have switched EMR programs and have been dismayed to find that they could not do a file conversion and essentially would have to start over with the new one. They felt that making a poor choice the first time around cost them considerable time and money. They had gone into it blindly thinking that if they wanted to switch programs that it would be easy and seamless because they are all the same. Unfortunately, they are not.

Myth #4: EMR software is the bulk of the total cost
Adoption of an EMR can be quite a pricey endeavor. EMR software adoption for larger facilities can cost millions of dollars.  When budgeting for the transition, many make the mistake of thinking the software will be the majority of the cost incurred.  This couldn’t be further from the truth. Many EMR implementations will require additional hardware, additional staff, training for users, and many times the use of “super users” to assist during go-lives. Equipment within an office will have to meet certain system requirements in order to operate EMR software. The data entered into the program will have to be stored on some type of server or infrastructure. Additional staff may need to be hired to ease with the change in everyday workflow. Most will need to hire or acquire system experts at some stage of the implementation to be onsite to answer any and every question that should arise. When all this is factored in, the software ends up being the least expensive portion of the transition.

Myth #5: The technology is the hard part
As a veteran of numerous EMR implementations, I have experienced many highs, lows, and in-betweens and here is the sum benefit of my “wisdom”. Going into a go live, the common belief among physicians and staff is that learning the software will be the most difficult part of EMR adoption. However, they quickly come to understand that the greatest challenge lies in the processes and workflows that must be changed to make adoption of the software successful. Prior to EMR adoption ambulatory practices have their daily routine that they have done for years on paper. They often overlook that things as simple as vitals and patient history will now have to be entered into a new system and not just written down. This change can prove difficult for the staff regardless of how much training they have gone through or walkthroughs they have been given. It is always different when you flip the switch and bring something live. The first time you have real life patients in front of you and have to enter information into a system in their presence can prove difficult. Others will find it difficult to incorporate a computer into their clinical routines.  It is important to try and match the workflow with the program to ease the transition.

These are just a few of the common myths that I have personally come across in my experience implementing EMR systems. This doesn’t address all the concerns that are out there. But as any implementer can attest, the adoption of EMR is an ongoing process and an ever evolving one.

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