Before buying an EMR system, learn from others' mistakes

A practical look at information technology issues and usage

By — Posted June 22, 2009.

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If you talk to 10 physician practices after a major technology implementation, you'll likely get 10 different stories about the lessons they learned.

So what is the biggest mistake? Experts say it's not listening to those doctors and learning from their experiences.

Consultants say no matter whether you are a hospital or small physician practice, or whether you are implementing an electronic medical record or an e-prescribing system, there are patterns in the mistakes made during the shopping for and implementing of technology.

"In medicine, there will be times when people try things and they will turn out to not be the best things to do. You don't want to be in a situation of making a mistake when "all you had to do is check with somebody to find the appropriate way to do things," said James Jose, MD, a pediatric critical care doctor who is director of medical informatics of Children's Healthcare of Atlanta.

Richard C. Howe, PhD, vice president of business development at Healthcare Informatics Associates, said he, too, has seen several implementation projects fail after trying to go it alone without asking for advice from experts or peers. HIA, based in Bainbridge Island, Wash., provides health IT consulting and implementation services.

Experts such as consultants, trade groups and user groups, have a wider pool of experiences to draw from, Howe said. And peers are important because they can provide an overview of what problems they ran into and how they solved them.

Finding the right practice to talk to, and figuring out the best questions to ask, may take some homework and planning. But it's worth the time and effort.

Karen Colorafi, RN, an independent consultant from Phoenix, said most practices start with a long list of possible vendors. Once that list is narrowed down to two or three, "I would definitely recommend not just picking up the phone but, if you can, do a site visit" to a practice using the system.

Every vendor has a list of references for potential clients to talk to. While references can be helpful, they shouldn't be your only source of information, Dr. Jose said. National conferences are a great place for networking and meeting people, he said. Other references often can be found through national organizations such as the Healthcare Information and Management Systems Society or the American Medical Informatics Assn.

But the best source, according to Dr. Jose, are the "benchmark organizations" that you look up to. Find the practice that is where you want to be five to 10 years from now. Talk to the people there and find out how they got there and what was learned along the way. Dr. Jose said most practices are willing to share their experiences.

What to ask EMR veterans

Experts say there are a handful of key questions that should always be asked of references, whether you found them on your own, or through your potential vendors:

  • If you had it to do over again, what would you do differently?
  • Would you recommend the same vendor?
  • Did you budget correctly?
  • What are the ongoing maintenance costs?
  • How long did the system take to implement and what were the problems you encountered?
  • How did you handle converting data from paper to electronic? How was data abstracted?

Just being aware of the most common problems can help guide you through the process, experts say. HIA's Howe said even if a practice is satisfied with its vendor overall, chances are things did not go perfectly and something was learned along the way.

Sidestepping pitfalls

The following are among the most common mistakes that have clearly been defined, and can be avoided.

  • Underestimating workflow changes. Talking to practices of similar size and scope will help give you realistic expectations. Dan Rodgers, president and CEO of MedCo Data, a Tampa, Fla.-based consulting practice said practices also should evaluate workflow before implementation and develop the ideal workflow for postimplementation.
  • Not allowing enough time for training. Howe said he has heard several vendors use the sales pitch that their systems require no training. Talking to someone who uses the system will verify that's likely not the case. There are no plug-and-play systems, experts say.
  • Treating the project solely as an IT project as opposed to a business decision. "If you are a pediatrician, you are in the business of treating kids; if you are an orthopedic [specialist], you're in the business of running an orthopedic group," said Howe. Whatever system you select should support that business.
  • Failing to consider future needs in negotiations. Rodgers said just implementing the core will likely mean the practice will have to go back to that vendor for more. Rodgers said practices should negotiate those prices at the time of the initial implementation and have the vendor sign off on a statement of intent to purchase. Otherwise, you are stuck with a vendor who, after the fact, can set any price, he said.
  • Not defining a clear path for return on investment. Rodgers said many practices jump in, accepting the vendors promise of profit, but don't sit down and develop a plan to get them there.
  • Not having a legal expert review the contract. "When you are getting ready to sign a $50,000 contract, it's worth a couple hundred bucks to have someone review that contract for you," Colorafi said.
  • Going cheap on the infrastructure. Rodgers said he has heard from several practices that say their systems aren't performing the way they were promised. In reality, he said, they were running the systems on older, less-expensive computers and servers that weren't allowing the system to run at optimal levels.
  • Delegating the implementation to nonphysicians. Colorafi said she has seen many implementations fail because the job of selecting a system was delegated to a practice manager instead of a physician who will be using it. Others can be used to gather background information, she said, but taking the systems for a test run should fall to the physician.

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