Get Ready for EHR Failures, But Don’t Blame the Software


Chief Operating Officer,

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).

  • Ignacio Valdes, MD, MS

    This is from another conversation I wrote but I think it fits here:

    Years from now I hope that people will laugh at these debates in the same way that today we think the alchemists where misguided. I hope
    that laugh will happen in just a few years, and not 20. Do you remember the Steve Martin ‘Medieval Barber’ skits in which he does blood letting on customers then starts talking into the camera, lays out the discovery of the scientific method then grins into the camera and says ‘naaaah!’ and continues doing dreadful things? That’s what seems to be going on here a kind of ‘Medieval Barber’ type thing that is occurring with many people in thinking about Health IT. That this proprietary vs. Free/Open Source licensing is even debated just seems so odd to me.

    Mandating seat belt use for cars isn’t a good thing because ‘one size does not fit all’ and people should be allowed to be ‘thrown clear’ in a crash. You know that lead paint is pretty good for some applications and it is just too bad if it poisons children and the environment
    around it. Banning lead paint and faulty medications is not a good solution because it works for some people and ‘one size does not fit all’. Freedom of speech should be you know optional because ‘one size does not fit all’, the scientific method for finding truth is really superfluous because ‘one size does not fit all’. Proprietary EMR’s should be allowed to be paid for with federal funds because ‘one size does not fit all’ even though there is manifest evidence over at least
    a decade that they do not work very well in practice for most of medicine and there is a good deal of evidence over decades that
    Free/Open Source ones do.

    How is it possible that the VA computerized themselves very effectively as far as anyone can tell without proprietary EMR’s and proprietary EMR vendors? That a large reason for their success is that they made a conscious decision long ago to do something that pre-dates Free/Open Source and looks very much like Free/Open Source? Or is this yet another instance of ‘one size does not fit all’? For the VA, one size very much does fit all as long as software freedom is safeguarded in both the hospitals and clinics with demonstrable superiority.

    I’ll repeat that it isn’t what you see with proprietary EMR systems, it is what you do not see: rapid innovation, choice, actual scientific comparison, real privacy, security, derivative works, the right to fix and extend the software, low or no cost, good service, real progress in medicine. What you do not see with Wal-Mart and eClinical is the poisoning of the health IT software ecosystem and the stifling of innovation and derivative works while we collectively go ‘Look over there! Something shiny!’

    Overall, the private sector Health Information Technology seems to drink the same polluted proprietary water over and over again and
    wonders why it is sick. Does anyone wonder why it is necessary for a $19 billion hammer to mash that proprietary square peg into the round
    hole? Could it be that one size fits all rights to run, copy, distribute, study, change and improve the software are really essential just like the scientific method, and public safeguards banning harmful things like lead paint and mandating seat belts?

    – IV

  • Peter Yellowlees

    I agree with your list, but think that the issue of being prepared to practice differently should be at the top. We all know that healthcare is a very inefficient provider focussed industry, and when moving to implement any major type of application it is crucial to re-engineer the work process before choosing the application – there is no point in trying to put in an electronic application to solve a business process problem – the end result will be worse.

  • Basmah

    Hi,i’m trying to find the information of percentage of EHR failure in google but i couldn’t.Can you tell me from where u get this information

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