How EMR Process Issues Screwed Up One Small Practice

Posted on January 31, 2011 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Here’s a story which I’m sure could be retold in practices around the U.S.  It’s a tale of how EMR process issues slowed down care to a crawl.

I recently visited small OB/GYN practice — a busy and seemingly prosperous one in a wealthy suburb — which had just implemented a popular EMR package. Knowing how small practices are struggling to make EMRs/EHRs work, I took a suspicious look around.

From the looks of things, everything was in place:  the EMR was available at every workstation used by clinicians and nurses, doctors had carts to roll their e-charts into exam rooms, and the use of paper was minimal.

Then, it was my turn to be seen, and the EMR (in theory) came into the picture. Whoops!  Things went downhill pretty fast.

First, I had my vitals taken by a medical assistant, all of which went onto a piece of paper.  Couldn’t she have had access to one of those carts?   Was the practice too cheap to buy enough terminals to make this not-so-cheap EMR a success? Process failure #1.

Then, I was moved along to a nurse to be asked some additional questions. Though the nurse seemed patient and careful, she had to ask me about my medications three times, because something about the system interface led her to dump the data over and over.  I’m not blaming the nurse (I blame the vendor and their UI) but that was definitely process issue #2.

Then, I finally had a talk with the doctor.  She didn’t make use of  the EMR at all!  She did look at some of the paper I turned in during my waiting room stay, and clearly listened carefully to my concerns, but didn’t take notes during the whole conversation, EMR or no.

I thought one of the great things about an EMR was to normalize how notes were taken and preserve the value of them from the point of care on.  Process issue #3 and the EMR is outta there!  (Well, I wanted to pitch it anyway.) Just how much clinical value could they be getting from this fractured way of doing things?

Folks, I have no idea how long the EMR had been in place there. This could have just been growing pains.  But my instinct is that more likely, the place is going to keep running its EMR in a hodgepodge style until it  begins losing clients or gets punished harshly for its inefficiency. Which do you think will happen first?