Aside from the disruption during roll-out, many EHR programmers don’t really ask what physicians want. A typical IT top-down mentality:
Few developers have asked the physicians what they need. Fewer developers understand why they encounter such massive physician resistance. Those who have tried to understand the resistance can not get a straight answer . .. . . I think the reason is that software developers are oriented toward the hospital as their customer and not the physician. Hospitals have money to spend on capital improvements. Physicians do not want to spend large amounts of money on anything, especially something that they perceive will add little value to their practice. In fact, the EMR might hurt their practice.
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{ 4 comments }
I always thought that it was because docs were relatively techno-phobic.
DocMalk (not techno-phobic, but I worked in IT for a while)
The reasons that EHRs are not more popular is because they cost too much, do not improve reimbursement(because reimbursements have been cut and frozen= no money for capital improvement), and require physicians do be typists or hire scribes. IS people do not live in the clinical world.
Our Primary Care group went through a very successful implementation(6 years now) but there were/are some problems I have observed.
1. Scribe.. I do Dragon. I’m fast. Lots of guys won’t do it…Stubborn. Old dogs…They guys who are slow are the ones who took home piles of charts to dictate on the weekends.
2. “Improved care?” Marginal. We didn’t adopt it for that reason. Too bad. Our inconsistencies between providers is quite transparent now.
It did improve access to info at different sites.
3. Cost. We paid for it in 5 years. Our incomes are still down… Primary care woes. Hard for me to argue thast it is an “answer” for primary care with the pattern of reimbursement. And kick in another 10% for P4P and we’ll be back up to what we made 10 years ago, 1/3 what a specialist makes…
I am not a techno-phobe. I have built several computers–one in 1976 that was a kit called the KIM-1–had to solder in the parts. I have learned 3 programming languages, have built and designed analog electronic circuits, and now work for an IT company as a full-time consultant. Yet I still have a problem with EMR.
The clinic I was with decided to go to electronic prescribing. I show up one day to find that they have installed a computer with the necessary software in the receptionist office. I don’t walk into the receptionist office to write prescriptions. I am a psychiatrist and have one office and am not going to change my work flow and go down the hall leaving patients tooling around my office while I write Rx. Result: I never even try to use it–a waste.
Round two: Clinic decides to get more physicians on the computer and save money on PDR’s by having us use the PDR on the mainframe. I take the lesson. To do so I have to leave my office (while the patient digs through my files I suppose) and go to the receptionist’s office. I counted the keystokes required. When I got to 50 and still wasn’t in the PDR, I walked out.
Round Three: I get a laptop and printer in the office to access partial EMR and print RX. It is ok–usually. It saves time when there are refills with no med changes but changes take more time than handwriting as the old Rx must be canceled line by line, reasons typed in, etc. When an error is made, it adds 5 min to the visit redoing it all and telling the software why. I handle it. But some patients don’t want their Rx in the machine (esp IT professionals!) so I am a “noncompliant physician” in not using it 100%.
Round Four: The clinic demands that I put all my old psych records in the new mainframe EMR system. The protocal is that they will be sent out when medical records are requested without a specific authorization from the patient releasing psych records. This is a violation of what I told patients over 20 years would be the way their records would be managed and is unacceptabl eto them and to me. I dig in my heels to protect my patients privacy. Numerous contentious committee meetings later, the policy is finally changed only I get lawyers into it.
I am not a technophobe. I type faster than I write. None of the above cost me anything directly. The plain fact is that I can do it better and faster on paper and, most importantly, more easily keep control of the information, which is something that my patients expect me to take responsibility for. My experience shows me clearly that I can not trust others to give privacy it’s proper value.
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