Some of the best and most objective information about EMRs comes from the Center for Health IT at the American Academy of Family Practice. Real doctors who have purchased EMRs rate their EMR in 5 different categories: Quality, Value, Usability, Productivity and Support.

This report is ONLY available to members of the AAFP. I think if the AAFP really wanted to do all of us a big favor, they would release this report to anyone who is interested in seeing it. I don’t understand why they are keeping it secret.

It is going to be very difficult for doctors to find a good EMR because there are so many EMRs and so many “bad” EMRs (hard to use, reduce productivity, expensive). Starting with this survey can help doctors start their EMR search on the right foot.

Contact the AAFP and ask them if you can get a copy of their report.

Center for Health IT

Hopefully they will have our great Healthcare System’s best interest at heart. By making this report available to all doctors, they can help us all get “good” EMRs that are usable and high in quality.

If you are a doctor looking for an EMR, start your search with a few EMRs that get good ratings in this survey.

I just read Ryan Rick’s guest post on Phoenix, Arizona EHR Uninstalls and I remembered a New York City Health Department’s project called Primary Care Information Project (PCIP) headed by Dr. Farzad Mostashari. I see big problems for Dr. Mostashari’s project. I predict many uninstalls and ultimately a low successful implementation rate. They have good intentions but are making classic mistakes which will ultimately prove to be their undoing. I hope what they are doing will work (because I am a big fan of EMRs), but let me outline a couple of critical weaknesses in their plan and then we will see how things work out for them over time. I think all “top down” EMR implementation organizations will take note of this experiment.

I think Dr. Mostashari has bought into the notion that implementation has to be daunting and hard. “Our experience here is that it’s just hard,“ Dr. Mostarshari said. He thinks like Dr. Middleton, “A crucial bridge to success, according to experts, will be how local organizations help doctors in small offices adopt and use electronic records. The new legislation calls for creation of “regional health IT extension centers”. In a letter to the White House and Congress last month, Dr. Blackford Middleton, chairman of the Center for Information Technology Leadership, a research arm of Partners Healthcare in Boston, and 50 other experts emphasized the importance of these centers and pointed to the Primary Care Information Project in New York City as a model.” — Steve Lohr, How to Make Electronic Medical Records a Reality, New York Times, March 1, 2009.

Implementation is daunting and hard if you pick systems which are NOT simple, NOT easy to install, NOT easy to learn, and NOT easy to use. PCIP in New York City is using eClinicalWorks which has a good reputation, but I am NOT sure it is simple, easy to install, easy to learn and easy to use. If eClinicalWorks had all the “simple and easy” characteristics, then I don’t see why the implementation would be so difficult and daunting.

Dr. Mostarshari is also moving very aggressively and fast. Not a good idea in my opinion! He is rolling things out to the whole system before seeing what works and what does not work. “The city Health Department’s Primary Care Information Project (PCIP) has already converted over 1,300 physicians and 226 medical practices to EHRs”. Record Recovery, Center for an Urban Future, page 5, June 2009. www.nycfuture.org. I think the project is only a couple years old.

Ryan Ricks, of XLEMR, makes a series of suggestions in his post which I believe are extremely important. “It seems that Arizona physicians are scrambing to remove unusable systems due to poor selection or botched implementations.”. “Physicians need to be careful and not rush into a decision they may regret.”. “Physicians should focus on their needs … and select the simplest system that fulfills their requirements”. “Simple systems are easy to install, easy to learn, and easy to use.” “Ease of use is critical; complex and difficult systems can lead to spiraling maintenance and training costs, and may ultimately be discarded”. “They should take their time to find a simple, user friendly system that meets their needs.” — Ryan Ricks, XLEMR Update Newsletter, July 2009, www.xlemr.com. Mr. Ricks makes some excellent points. Water flows downhill very nicely, but it takes a lot of energy to pump it to the top of the mountain!

It is my feeling that implementations would be less daunting and more successful if the EMR systems were less complex, easier to install, easier to use and easier to learn. Doctors are smart people who can learn to do stuff without handholding and constant supervision and oversight. The fact that the New York City PCIP Project needs all this hard work and all this effort and all this money makes me suspect that they have made major mistake in choosing an EMR system that is too complex, too hard to learn and too hard to use. Their second mistake is moving very rapidly to roll it out to the whole system before removing the bugs (the bug may be eClinicalWorks).

This top down approach is doomed to fail. Doctors must be able to choose the systems which works for them. If you have to ram it down our throats, it will be regurgitated at some point when we just get fed up. This happened in Pheonix Arizona, is going to happen in New York City and, if we are not careful, may happen in the whole country if things are not managed in a smarter manner. This is also a warning to Hospital Systems which are working in a similar “top down” manner to provide EMRs to their employed physicians and their private physicians (via the 85% rebate model). We don’t need Regional Health IT Extension Centers and we don’t need large organizations forcing us to use THEIR preferred EMR. We need to be using EMRs which are easy to install, easy to use and easy to learn! We need to identify those EMRs and promote them aggressively.

Our next guest post comes from Ryan Ricks of XLEMR. In this post Ryan compares the ARRA EHR stimulus money with Governor Napolitano’s mandate to adopt EMR software in Arizona and the alarming EMR uninstall rate.

The HITECH Stimulus Act is part of President Obama’s plan for full, nation-wide use of EMRs by 2014. The act promotes Electronic Medical Record (EMR) adoption by allocating funds to reimburse physicians for purchasing and using a qualified EMR system. In addition, physicians who fail to adopt an EMR will eventually face Medicare reimbursement penalties. Although the goal is lofty, Obama hopes the act’s carrot and stick approach will encourage physicians to adopt EMRs.

However, a recent report by HealthLeaders-InterStudy indicates that Phoenix, Arizona is experiencing a high rate of Electronic Health Records (EHR) uninstalls. According to the report, the trend is due to training, functionality, or affordability issues. Both top-level hospitals and smaller providers struggle with the financial constraints of purchasing and implementing EHR systems. Arizona rapidly adopted EMR systems due to a 2005 executive order by Governor Janet Napolitano, which required that all healthcare providers install an EHR by 2010.

Does this uninstallation trend provide us a glimpse into the future? Will the U.S. share Arizona’s experience at the national level? Arizona’s executive order is similar to the HITECH stimulus act because both seek to rapidly drive EMR adoption to meet an arbitrary deadline. In both cases, physicians feel pressured to make a very important and potentially very expensive decision. Although EMRs provide many benefits, selecting the wrong system, or rushing the implementation process could lead to many problems. It seems that Arizona physicians are scrambling to remove unusable systems due to poor selection or botched implementations.

This does not necessarily mean the HITECH Act will fail. Rather, it means that physicians need to be careful and not rush into a decision they may regret. EMR system prices can reach $100,000 or more. In contrast, the stimulus act will only pay about $44,000 in reimbursements. Physicians should focus on their needs, not wants or superfluous features, and select the simplest system that fulfills their requirements. Simple systems are easy to install, easy to learn, and easy to use. Ease of use is critical; complex and difficult systems can lead to spiraling maintenance and training costs, and may ultimately be discarded.
The uninstallation trend in Arizona is a clear warning. Although well-intentioned, the HITECH Stimulus Act may encourage physicians to rashly purchase a system that will not work well in the long run. Physicians must resist the temptation throw in a system just to qualify for reimbursement payments. Instead, they should take their time to find a simple, user-friendly system that meets their needs. After all, $44,000 sounds like a lot of money, but it will probably not cover the more expensive EMR systems with monthly maintenance fees.

At EMR and EHR we welcome people to submit guest blog posts on our contact us page. We’re happy to post them with your name and a link to your website or anonymously. This week’s guest blog post comes from a doctor who wishes to remain anonymous but has some real questions about CCHIT’s involvement in the EMR world. Enjoy!

Companies are lobbying the Administration to keep product-testing and standard-setting within the sole jurisdiction of a nonprofit body called the Certification Commission for Healthcare Technology. Founded in 2004 with industry money and grants from nonprofits, CCHIT now receives $7.5 million a year under a contract with the federal government. The other half of CCHIT’s $15 million budget comes from fees paid by companies. Mark Leavitt, chairman of CCHIT, is a former tech vendor. He sold his electronic health records company to GE in 2002 and later became chief medical officer of the Healthcare Information & Management Systems Society (HIMSS), a trade group in Chicago. Seven of the CCHIT’s 19 voting members work for vendors or for-profit tech consulting firms. -– Chad Terhune, BusinessWeek, May 4, 2009, The Dubious Promise of Digital Medicine: Why huge spending on electronic records won’t produce quick improvements in efficiency or care.

$15 million dollars per year! To do what? Where is all the money going? I wonder how much Mark Leavitt makes per year? How much are the voting member paid per year? Boy, would I love this job! And what about the fact that almost half the voting members work for vendors or consulting firms! Is there a conflict of interest?

Does anyone have any additional information on CCHIT? This really makes me curious. Alarms are going off all over the place when I hear the basic information about CCHIT, how much they take in per year ($15 million) and what they actually do (certify a few EMR Systems).

In Washington, where partisan bickering over how to revive the economy flares on several fronts, sweet consensus reigns of heath-tech spending … lawmakers cheer electronic records as a business-based remedy for much that ails medical care … That rare agreement, however, is obscuring the checkerboard history of computerized medical files and drowning out legitimate questions about their effectiveness. Cerner, based in Kansas City, MO., and other industry leaders are pushing expensive systems with serious shortcomings, some doctors say. The high cost and questionable quality of products currently on the market are important reasons why barely 1 in 50 hospitals has a comprehensive electronic records system, according to a study published in March in the New England Journal of Medicine. Only 17% of physicians use any type of electronic records. – Chad Terhune, BusinessWeek, May 4, 2009, The Dubious Promise of Digital Medicine: Why huge spending on electronic records won’t produce quick improvements in efficiency or care.

I have to agree with the above assessment.

“Industry leaders are pushing expensive systems with serious shortcomings” and
”The high cost and questionable quality of products currently on the market are important reasons why” … many hospitals and physician groups do not use EMRs.

I am interested in hearing your opinion on this matter. I believe that there are great systems out there. Why are they so hard to find? Why aren’t doctors finding them, buying them and using them?