Please take care in selecting an EMR for your practice

As reported by HDM on-line, the Office of the National Coordinator for Health Information Technology has published additional information on a $598 million grant program to fund the creation of about 70 Health Information Technology Regional Extension Centers.  The centers will help hospitals and physicians select, acquire and use electronic health records systems.

No doubt some serious education and hand-holding will be needed as more physicians and hospitals take the plunge into electronic medical record systems and “meaningful use”.  If taking the plunge is anything like what I saw and heard during a visit to my own doctor last week, doing your EMR homework before you buy is an important step if you hope to swim rather than sink.

  My doctor belongs to a very large, multi-specialty group practice.  Like most large clinic systems in America this group practice, which also operates a hospital, has been using electronic records for some time.  Even though the multi-specialty clinic drives most of organization’s business, they decided to purchase a health information system that is better known for running hospitals than outpatient medical centers.  As long as I’ve known my doctor, he’s been complaining about the EMR system he is forced to use in the clinic.

And it’s not just my doctor who does the complaining.  On my visit last week, the first thing his assistant did while checking me in was to verbally assault the blankity-blank computer system. She clicked furiously on the screen multiple times waiting for the system to respond.  Just entering my vitals seamed to require clicking through endless screens.  It took a ridiculous amount of keyboard work.  “I hate this system”, she said.  “It is always slow, especially when we are busy.  And several times a day, it just goes down”.

She eventually got through all the screens and entered my data, although I noticed that she took down my chief complaint and medication list on a sheet of paper perhaps to enter that information into the computer later.  My doctor came into the room, asked me a few questions, and did a cursory exam.  Mainly I was there to get some prescriptions renewed.  My doctor also decided to order a few lab tests on me while I was there.  On my last office visit, he had ordered lab work on the computer.  This time he used a sheet paper.  Before I even had a chance to say something about this he blurted out, “I suppose you noticed that I’m back to ordering lab work on paper.  We tied CPOE (computerized physician order entry) but it just took too long!  The clinic docs revolted, so now we are back to doing it the old fashioned way.”

Of course, I could have predicted all of this.  There are much better solutions on the market for ambulatory patient care than what my doctor is being forced to use .  There are far more intuitive and responsive EMR solutions.  There are also solutions that are more accommodating to clinical workflow and mobile scenarios using Tablet PCs and other wireless devices.  But my doctor’s group practice spent millions of dollars on what they have, and I’m quite certain they won’t be trashing it anytime soon.

So, let this be a warning.  Do your homework.  Select a system for your practice with the research and care you would put into making any large, really important purchase for your home or business.  Don’t delegate this to your staff.  It is your responsibility.  You, your staff and your practice will be greatly impacted by the decisions you make.  So maybe, just maybe……. a visit to one of those government funded “extension centers” would be a good idea before you take the plunge.

Bill Crounse, MD  Senior Director, Worldwide Health   Microsoft

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