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Winning Over Anti-EMR Partners

October 16, 2007
by Steve Ryan, M.D.
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When trying to garner support for an ambulatory EMR, don't be stymied by the first signs of resistance.

Every day more and more physicians' practices, hospitals and other healthcare organizations are adopting an electronic medical record (EMR). Our national government has given its opinions on the benefits. The non-medical press is covering the transformation on a fairly regular basis. Every major specialty, in their national meetings, seems to be offering information to its members on the transformation to computerized patient information management. It comes up in doctors' lounges.

However, in none of these settings are actual EMR purchase and implementation decisions made. These decisions are commonly made in discussions and meetings among the financial and medical leaders in a medical practice. Often, in these settings, there are physician partners who are reluctant to make the transition from the traditional written and dictated medical record to the electronic.

It is vital in the very earliest stages of discussion to understand and openly face the concerns and objections. Failure to successfully keep this discussion pleasantly moving forward will likely doom the move to an EMR to an early dismissal or to a protracted and unpleasant implementation with many lingering hard feelings. It is even possible that it could lead to the complete failure, for either financial or personal reasons, of a partnership or group practice.

I started my odyssey toward an EMR in October of 2002. I had been a partner in a multi-specialty group and was leaving it to start, with my office partner of ten years, a small family practice office. I went to a national office management conference in Florida, where one of the lectures really piqued my interest in EMRs. Upon coming home to Colorado Springs, I researched and convinced my partner and our office manager to change our ways away from paper and we went live with Allscripts HealthMatics EHR in June 2003. Paying attention to open discussion of all of our concerns, we had a rather rapid and a very smooth decision making and implementation process.

Over the years since our installation, since I have become somewhat of an EMR evangelist, I have talked with many physicians and managers. In fact, my wife is an obstetrician-gynecologist who is in a five-physician practice. She was previously not at all oriented toward computerization, but has come to see the benefits and is now looking forward to using digital media in her patient care. Unfortunately, two of her partners are completely opposed to the whole idea. There are, in general, three major areas of resistance.

The initial objection for many is just "the thought" of having to use a computer. Sometimes, this is not even completely recognized and just expresses itself as other concerns are continually raised. It is difficult to convince the inexperienced computer user that things can actually be easier than the old familiar pen, paper and tape recorder. Two things may help decrease computer anxiety.

First, try to help others realize the benefits that they already unknowingly receive from computerization. Many people, who otherwise would not touch a keyboard, will correspond and exchange digital photos with e-mail. Explain that ATMs are just computers that track money and give it out 24 hours per day. Online news, weather, travel, sports and medical information are often utilized by the computer un-savvy, yet they do not think of these as "computer work." Good EMRs can be as intuitive and smooth as good Web sites. Second, try to help them understand that they will not have to go through it alone or figure it out themselves. Again, good EMRs come with lots of training and adapt their instruction to all levels of students — from hand-holding and baby steps to higher levels of customization.

The second objection, and often the first one actually verbalized, is the cost. There are some very inexpensive options out there. A search through physician management journals will offer suggestions. Typically, though, most practices will be looking for full-featured solutions with unified or linked practice management systems, training, support and coordinated product development and evolution. Though there is considerable variation, these options tend to be more expensive.

In trying to get past this objection, it is important to review the current costs of generating, using and storing paper charts and dictation. Direct and obvious expenses include the actual costs of the folders and paper, tape recorders or phones to get to the transcriptionists, transcription fees, costs of copying and sending records and records clerks. Transcription is expensive. For the EMR, such costs include the EMR software itself, training, hardware, yearly license, support fees, and local hardware maintenance and repair. Most of these numbers should be readily available and may well, if compared over a three- or five-year period, be enough to convince the skeptic of the financial benefits of an EMR.