With the Economic Stimulus Bill signed and available to subsidize EHR purchases (for more information see “The Stimulus Bill and Meaningful Use of Qualified EHRs/EMRs“), we are seeing a dramatic increase in electronic health records (EHR) buyer interest. Assuming these buyers make use of the stimulus subsidy to buy an EHR, we expect to see a lot of EHR failures over the next couple years.
Don’t get us wrong! We are HUGE advocates of EHR technology. Doctors should be using EHRs. The stimulus subsidy is great. EHR software programs (and software companies) are not the problem.
Our concern is that the subsidies won’t change healthcare providers’ late adopter mindsets about information technology. Providers may jump at “free software” and try to avoid penalties (starting in 2015), but will they:
- Truly believe in the value of an EHR over traditional paper charts?
- Take a leadership role in advocating adoption of the new EHR in their practice?
- Change their old workflows to match the best practices in leading EHRs?
- Take part in intensive training to learn the new system?
- Ride out the difficult stages of new software adoption and change management?
Traditionally, the substantial costs of EHR systems keep the luddites from buying technology in the face of these challenges. But with “free” EHR software, we expect more than a few providers to throw caution to the wind, buy an EHR and overlook the critical implementation and change management practices that are critical to success.
The best things in life are free, but that doesn’t refer to healthcare IT. We think providers would be far more serious about implementation and adoption if they had to pay dearly for the technology.
Accordingly, here are our thoughts on why IT projects fail and how providers can avoid that fate while still capitalizing on this once-in-a-lifetime subsidy.
When and why do IT projects fail?
In 2007, the U.S. Office of the National Coordinator for Health IT reported that about 50% of EHR implementations failed. IT industry analysts widely agree that software implementations fail because of the customers. It’s too easy to point the finger at software vendors or at the software itself, but failure usually is the buyer’s fault. In a recent survey, one group identified the following top reasons for IT implementation failures:
- ~40% attribute failure to poor planning and communication;
- ~20% cite mismanagement and rejection by end users; and
- ~15% blame overspending.
Very few doctors use EHRs. In fact, most predictions put EMR market penetration at 10%-15%. We all know why this figure is so low: doctors don’t want to use them, practice staff is stuck doing things “the old-fashioned way,” etc. Now that Uncle Sam is willing to pay for EMRs (and telling us we had better buy!), a lot more practices are going to adopt them. The scary thing, however, is that the same feelings that have slowed the adoption of EMRs are still prevalent.
Here let me present what I think are 5 critical steps for a smooth, successful EMR implementation:
1. Become a project manager. If you’re a physician, you may not consider yourself a business person. However, for this project, you need to become a project manager. If you’re lucky, you may have a staff member or consultant that can play the role for you, but don’t count on it. First, create a project plan. Outline all the steps of your implementation so you know what changes need to occur by certain deadlines. Stay on top of the plan and hold your team accountable.
2. Rally everyone else. Recall that poor leadership and lack of user adoption are frequently cited as contributing factors to IT failures. You need to express confidence in the technology and get your staff on board before the implementation. Show how much easier their lives will be. Get them excited about it. Tell your patients that next time you see them, you will be a computer whiz with a slick EHR.
3. Buy the best training you can. The government is paying for it (laugh). Seriously though, you will need the help. It’s too easy to skimp on adequate training and ongoing support. Don’t risk failure of an investment because you want to save a few thousand bucks. It’s worth it. Get trainers in the office, send the staff to training, implement a train-the-trainer program.
4. KISS: Keep It Simple, Stupid. No office becomes paperless overnight, so don’t try to do everything at once. Ease into your new workflow as much as you can. Adopt advanced features after you learn how to turn on the computer. It is OK to implement bells and whistles after the initial dust has settled.
5. Be prepare to practice differently. As much as you don’t want to admit it, you will need to adjust the way you meet with patients and how your practice operates. And if you can, make easy adjustments ahead of time. Start carrying a tablet PC or dictating with voice recognition software. It pays to work out the kinks early on.
If you follow these major guidelines – and a lot more small steps in between – you’ll have a much greater chance of EHR success. Most importantly, wrap your head around being tech savvy and enjoying the new system. If you don’t, you’ll pay for it (one way or another).