“All happy families are alike; each unhappy family is unhappy in its own way.”
― Leo Tolstoy, Anna Karenina
When hospitals roll out an EMR, they go through complex and rich information-gathering process. Health IT leaders tackle problems of scale, systems integration and feature development with support from multiple leaders in other departments. There are best practices to consider and vendor selection processes to observe, references and case studies to collect, and user group meetings they can attend to fine tune their EMR rollout and answer questions.
But when it comes to physician practices, particularly the smaller ones that dominate the medical landscape, the way is not as clear. Often without even a full-time IT staff member to assist them in their selection process, EMR adoption by physician groups is far less structured. Sure, physicians may check references like their hospital colleagues do, explore customer case studies and participate in software demos, but in most cases their process is far less systematic and informed than that of a hospital.
What’s more, if their EMR implementation runs into trouble, smaller medical groups may have far less support than hospital IT leaders. After all, not only are they less likely to get much help in selecting an EMR, they probably don’t have a robust network of peers who can answer questions in context. Like any small business, they make their idiosyncrasies work for them, but when they get into trouble with IT they are unhappy in their own unique way.
Standardizing Physician EMR Adoption
Of course, practice leaders who are struggling with their EMR investment can turn to the vendor that sold them the system, but that can backfire pretty easily. While the vendor is obviously the last word on how the contract is structured, they may or may not have a strong incentive to address gripes and concerns, even if they are obligated to address outright failures of the system.
If the vendor offers a fairly open support model, practices may get some help as they evolve. But if their vendor charges by the hour for support, it’s unlikely many practices be willing to pay for the time to address anything but major problems. That may cut practices off from the knowledge and context they need.
Given these concerns, I’d argue that we need to develop a generalizable, reproducible model for physician EMR adoption and rollout. As I envision it, it should include:
- A standardized form smaller practices can use to identify their key needs, allowing them to pick and weight their priorities from an evidence-based list of key selection criteria
- A frequently-updated database, maintained by a third party, which collects physician ratings on how a given vendor meets these well-articulated needs
- A post-implementation form, once again drawn from research evidence, helping them identify and weight their EMR’s performance based on objective criteria
The idea behind all of this is to standardize physician groups’ EMR selection and rollout, and turn what can be a groping, uneven process into an evidence-based one. Not only will this help physicians from the outset, it allows for building a knowledge base which cuts across vendors, geographies, practice sizes and technical sophistication levels. If physicians had such tools, their process of learning would become iterative and collaborative in a far more effective way.
Don’t get me wrong, I know that virtually any software selection process will address issues that don’t make it into a model like the above. But if you offer practices a more structured way to adopt an EMR, they are more likely to be happy with their overall results. This is going to become even more and more important as small practices switch EHR software due to EHR consolidation and other factors.