The main problem for the majority of vendors appears to be one of marketing. These examples were chosen not only for their actual software solutions but for the clarity with which the solutions were explained. Most IT managers and vendors fail to understand that the end-users want some analytics on the savings in time and money presented to them prior to the on-site test. There is still a tendency to be vague and ephemeral assuming that doctors will adopt EHR solutions because it’s a really good idea for patients.
EHR documentation and database systems are generally perceived as a new technology that may or may not provide efficiencies with little or no tangible increase in patient care. A study entitled “Electronic Medical Record Systems in Critical Access Hospitals: Leadership and Perspectives on Anticipated and Realized Benefits” shows that, at the time of publication (spring, 2010), there had been no benefit seen at hospitals that had adopted EMR. This makes EMR/EHR a poor investment when compared to specialized equipment, such as MRI machines, which quickly pay for themselves and have tangible increases in patient health (CDC, NAS, and Stats Canada).
As an example, to install an MRI machine costs $2M. In most US states the average cost for an MRI examination is $2200, which means that the cost of installation requires only 1000 patients or approximately one year of average use for a machine that has a 10-30 year useful life (data from Pennsylvania health care cost containment council). In addition, the CDC reports that MRI is now considered a standard of care and therefore is a must-have item for hospitals to maintain and upgrade in order to remain competitive. Diagnostic equipment has a tangible return on investment to the frontline users (i.e. Doctors, nurses) and also can be a marketing tool in competing for niche patients (i.e. high yield patients). Since EHR does not have a readily apparent short term benefit to either the administration or doctors, there is little incentive for either of these parties to assist in moving EHR adoption forward.
Doctors are looking for three features from EHR:
- Easy to scan fields with user controlled input and output. The documents have some kind of quick
- Completeness of dataset for historical purposes. These patient records are meant to be shared between physicians and are a guarantee against malpractice.
- HIPAA compliant database solution with user controlled access. Control and security of the patient data is a paramount concern to hospital administration as well as doctors who are ultimately responsible should the data be lost.
For EHR implementation to go smoothly, and maximize cost efficiencies, IT managers need to take the initiative and follow these three steps:
- Ensure that the selection and approval process of the EHR solution involves care providers and administration in the same room. These meetings cannot be for show, all decision makers must be involved.
- Get to know who the key decision-making doctors are in each department and develop relationships. Some doctors are in favor of EHR, find out who they are in your hospital/clinic, and involve them in building a strategy for how to tackle the implementation.
- Get care providers on-board during the demonstration phase. Take your key decision makers through the products, and ask questions about the mundane parts of the software (e.g. first impressions of the GUI, how to access the records, etc.) not just the big-picture items.
Adoption of EHR/EMR has lagged behind the rate expected in the US market. This appears to be largely due to low end-user adoption. IT managers need to understand the end-user needs and get them on board during the adoption process to fix this problem.