I was recently talking with a colleague who is chief medical officer for a large integrated health system. His team has extensive experience implementing EHRs in small practices affiliated with the health system. He told me that when you implement one EHR in a small practice, you have implemented one EHR! The next practice has different workflows, different expectations, and variations that make standardization of implementation a significant challenge. However, if an EHR is not satisfactorily implemented, it sets the stage for many more challenges limiting effective use of that system.
Issues that practices face in regards to implementation include insufficient training, lack of appropriate templates, poor specialty configuration and problems with technical support. The following comments were submitted by clinicians who have completed the AmericanEHR Partners’ EHR satisfaction survey:
- As a beta site, we had terrible headaches with implementation, but now all the bugs are worked out. Works well, no problems for several years. Yes, I’d recommend our EHR, but I’d NEVER offer to help with development of a product of this type again.
- Every EHR selected has its own nuances and there is a learning curve for every system. Once one gets used to the processes and workflows, things become smoother and easier. The hardest part of any EHR is entering the first patient encounter and after that things flow easily.
- I think if we had more training (which my colleagues refused to buy), we would have had a better implementation. In my opinion, our vendor has not been very responsive and it is very costly to maintain this system. There must be cheaper systems out there. The documentation takes too long to complete an encounter. Too many steps and windows to open and close. It could be easier. But for report generating for QA it is great.
- I would re-purchase my EHR system but I have not investigated other systems to determine if they are better or worse. I think implementation and use in a small practice is easier than a large practice because in a large group various preferences and practice styles need to be standardized or create a large number of custom forms. The biggest frustration we have with the EHR is input of reports from other providers and facilities. Support staff can scan and index to the patient chart but transferring specific data such as meds, diagnosis and test results is very labor intensive. Additionally we do not feel comfortable delegating this to staff. Even if there was an HIE, how would this information get into specific data fields?
- Implementation consisted of team loading primary care type of information into a lab based Specialty practice — then leaving after teaching the office the basic input steps. No one has returned to demonstrate how to obtain or achieve ANY of the information queried in your survey. This is despite numerous phone calls. I, the physician, was reduced to rewording the template for a Nephrology based progress note and am now over 100 charts back logged.
- Implementation of the electronic medical record has made it easy to order labs and Xrays and easy to cut and paste notes into the chart. It has diminished the overall usefulness of the medical record, since everyone is cutting and pasting. I can no longer tell what was actually done for a patient amid all the jargon and extensive cut and paste lists. It is now possible to enter abundant information into one’s clinic note without even reading what is entered. Since every hospital (I attend three) and every clinic has an entirely different system with passwords and special tricks required to work with the system, EMR has made hospital consultation by a medical sub-specialist an exercise in futility. Has not lived up to its promise. I think because those who actually use EMR are not consulted and are generally just considered luddites if they ask for any improvements. frustrating.
- Implementation of this system has been poor. The web-based education did nothing to prepare us for the complexities of actual implementation. The “all or none” implementation model does not allow for any productivity during the implementation period. Step-wise implementation would allow for better understanding of how things are supposed to work. Work arounds in one step of the system lead to failures in other portions. Short cuts and abbreviations lead to confusion and failure. Onsite support is imperative to a successful implementation. Anything less is designed for failure.
- Implementation should be more standardized. Most docs end up using 4–5 templates so I felt I wasted a lot of time setting up a whole new batch. All docs buying the new system at the same time could have been trained on simple things like Rx writing. A check list to make sure the system was activated and the proper pharmacies loaded and an explanation of Surescripts etc would have been helpful. They forgot to switch that “button” on at the hospital that hosts the server. What a waste of time. Older docs have a hard time working on small tablets and viewing screens. Sounds great in theory but not in practice. I cannot be logged in in more than 1 machine so it would not even be helpful to buy new laptops and it is inconvenient to roll the computer cart into each room. The rooms are small , built pre-computer.
- Order entry, prescription entry and data review are not particularly user-friendly. These items require learning non-traditional formats to order tests, prescribe medications, and rapidly review test results and office notes. While implementation of EHR in our practice has allowed compliance with government-required mandates, overall practice efficiency and patient care have not been enhanced and in fact, have suffered somewhat. It is uncertain what testing was performed prior to implementation of this system (i.e. were health care providers allowed to give feedback) as many of the available features are in relatively unfamiliar formats – while feedback is given in our practice, it doesn’t appear to result in design/programming changes.
- Our EHR works very well and has really helped or practice. The greatest problem has been the implementation and the technical support. They are all competent and available, but the issue is none of us can understand them. We have never had anyone actually come to our office. Their staff has such strong accents that we can’t understand what they are saying most of the time and since everything is also done remotely, it makes it very difficult. Most of the time I try to figure it out on my own (which can take a lot of time) and I probably do not do it all correctly or as well as it could be done. I think there are several things that we do not utilize simply because we do not know how to do it, and it is too frustrating to try and be trained on it. Once things are in place, the actual system is designed very well and is very functional.
- Our implementation has been incremental. Patient management and E-Rx first, billing will follow. We have been successful so far with this approach and good support staff to shepherd us thru the process.
- The implementation of our EHR was particularly poor, with a key mistake being the incorporation of required physician behavior changes (e.g. mandatory staging and recording performance status for all patients when this is not required by the EHR. The requirement to use Dragon Dictate to enter dictated text into notes) that complicated the transition. The EHR implementation decisions were made by a small group of people involving very few clinicians – and NONE from surgical specialties and other ‘niche’ users with unique needs – so obvious productivity problems were not identified and have still not been resolved. In short, this implementation has been little short of a disaster. I have been involved with computerized patient care information systems since before there was such as thing as laptops, and I absolutely refuse to use the current system until the day they say I am fired if I don’t use it.
- Our main problem is implementation — not enough training to bring fully on line, even years later.
- The implementation of an EMR has been a huge undertaking heavily involving each member of my staff and myself. We are all now starting to see the rewards of this hard work in multiple ways and I am convinced it will have been well worth the effort in time, energy, money and initial lost productivity.
Do you agree or disagree with these comments? Share your experiences with EHR implementation.