Overcoming obstacles to EMR adoption

Frank Quinn
March 8, 2013 — 1,194 views  
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The economic recession of 2008 sent shockwaves throughout the entire world, transforming the very core of global commercial activity. As a result, measures were taken by the people in charge to mitigate the financial losses suffered by businesses, both on a national and international level. The healthcare industry was no different, where legislations such as ARRA and HITECH Act, enacted by the Obama administration, reshaped the practice of medicine on a fundamental scale. These laws proved to be the second coming for information technology in the healthcare sector and took the shape of a health IT renaissance. The use of technology in the healthcare sector has existed for quite some time, but was not as widespread and advanced. However, in essence of the CMS funded incentives and penalties introduced by these new laws, attention were focused upon the adoption of EMR like never before. For some, adoption of EMR solutions became a professional responsibility. Others were motivated towards adoption purely on monetary grounds. Either way, health information exchange became a phenomenon to be reckoned with in the healthcare industry.

For any practice, a lot of different aspects have to be factored in while making a complete transition from paper based records to electronic medical records. We are briefly going to shed some light on this subject and examine the salient features which are detrimental towards the choice of adoption.

  • The first and foremost factor for any enterprise prior to adapting a new design, methodology or technology is the intrinsic cost associated with it. A very small percentage of providers have sufficient funds to commit to an upfront capital investment for an EMR system. For any EMR solution, it's highly important for a practice to have the necessary resources. The total cost of the entire package including infrastructure, support and training must be taken into account as well. 

  • Time is another essential variable which must be deliberated upon while considering adoption. Most providers working in smaller practices (especially solo practitioners) fear that they might lose business whilst taking out the time to get their EMR system up and running. In the case of larger practices, conversion to an EMR system requires a lot of consensus and collaboration between managers and physicians before the system goes live. It's important that the practice staff and physicians are on the same page.

  • The manner in which EMR technology is implemented within a practice is a very tricky subject, and a lot of contemplation needs to go into it. One method is to implement the system all at once, where everything within the software launches simultaneously. This methodology requires abundant resources alongside a dedicated support team which caters to the needs of physicians in real time. An alternate way would be to gradually integrate an EMR solution within a practice which would provide a smoother learning curve for clinicians.

  • Proficient and thorough training provided by the EMR vendor to providers and their employees regarding the application is one crucial aspect which needs to be carefully considered. Research has shown that individuals receiving appropriate training exhibit better progress and higher user satisfaction. Training can help overcome the hindrance of usability which is innate to most applications.

  • 24/7 support from the EMR vendor is the key to efficient information sharing. In order for the software to operate in a smooth and productive manner, changes suggested by providers need to be incorporated by their vendors.

  • The main reason behind implementing electronic medical records within any practice is to address the issue of interoperability. The ability of an EMR application to seamlessly connect with other compatible health IT systems, such as health information exchange (HIE) is the essence of adopting EMR technology in the first place. A lot of the time providers complain about the difficulties they face with respect to integration with various components of their practice (for example finance, administration etc). Therefore, while deciding upon any electronic medical records solution, a rule of the thumb is to verify if the application complies with the industry benchmarks and standards of interoperability.

  • A major hindrance while making the transition from paper to the electronic world is abolishing the use of paper which physicians have become accustomed to. To overcome this problem, EMR vendors need to enhance the usability of their software, improve the workflow design and focus on the needs of the user. EMR vendors simply cannot ignore the fact that their users are usually at an age which cannot be considered as technology friendly.

  • Last, but definitely not the least is the important question of data migration while making the shift from paper to an electronic platform. Many doctors fear losing their data in the process and their concerns are justified. Logistically, data migration can be a daunting task for any EMR vendor out there. Clinicians need to ensure that the vendor they are going for has the appropriate solutions to their data migration needs.

It would be worthwhile to have a quick look upon some statistics towards EMR adoption at this juncture. Keeping all aspects of our discussion under consideration, by and large physicians across the nation have a positive outlook towards adoption. During 2011, 55 percent of clinicians nationwide had adopted an electronic medical records system. Approximately 75 percent of the physicians who have gone for adoption meet the government's meaningful use criteria. Most of the clinician population which made the transition to an electronic platform was satisfied with the results demonstrated by this technology. Almost half of the physician population which is currently without an EMR system is planning to convert to electronic medical records within a year's time. It is also observed that implementation of EMR systems is more popular within larger practices and hospitals. 62 percent of practices housing between 3-10 clinicians have already adopted and 86 percent of practices having 11 or more physicians have opted for adoption as well. Contrastingly, only 29 percent of solo practitioners were adopters at that point in time*. This statistic illustrates that smaller practices are still largely untapped by EMR vendors and is a huge potential market.

From a clinician's perspective, the time is ripe to opt for adoption as the market is flooded with EMR vendors providing configurable solutions for all sorts of specialties. Vendors even go to the extent of delivering ‘free EMRs' to practitioners; however, solutions which may be free at this point in time might prove costly later on by not meeting the requirements of meaningful use stage 2. Case in point, vendors are willing to go to painstaking lengths to provide solutions which can be customized for even a single provider. Nonetheless, physicians need to be very vigilant as to the direct and indirect costs of any solution before making a transition. On the other hand, looking at the situation from a vendor's standpoint, there is still a huge untapped market of practitioners which can be targeted. As advances in technology manifest themselves, vendors need to differentiate and come up with innovative solutions to make their mark in a competitive environment.

To conclude, the federal government's initiative has had a huge role in making the health IT industry what it is today. Most stakeholders within the healthcare continuum would argue that the industry has benefited overall as a consequence of the advances in technology. Though the long term advantages may not be evident as yet, inevitably the technology is bound to take healthcare to the next level.

* ‘Physician Adoption of Electronic Health Record Systems: United States, 2011' – http://www.cdc.gov/nchs/data/databriefs/db98.htm)


Frank Quinn

Over the past twenty years, Frank Quinn has contributed significantly on standardizing, interconnecting and institutionalizing care delivery through health IT, helping eliminate barriers to accessibility, quality and adoption. EMR, practice management, eRx, patient portal, medical billing, compliance, privacy and security are his areas of expertise. For more information, please contact Frank at [email protected]