Major Hurdles to Ambulatory EMR Implementations

There was a nice article in today’s NY Times about the current status of EMR implementations.  I’m fairly certain that the information gathered for the article was relating to hospital EMR implementations, but I found an important point to expound upon:

The government’s effort to try to encourage a market in digital health records, experts say, faces formidable hurdles. The risk is that physicians buy lots of computer hardware and software, but see no improvements, leaving a legacy of wasted money, angry doctors and disrupted care for patients.

So what are the major hurdles besides the fear that no improvements will happen? The number one hurdle to implementing an EMR is getting the entire organization to take on the project, not just the Information Systems staff.  The more people that have ownership in the project, the more likely it will succeed.  The most successful implementations I have seen have active support from numerous non-IS department staff members.  This included physicians; which brings me to the second hurdle.

Physician acceptance is  a make-or-break attribute of an EMR implementation. There absolutely needs to be at least one Physician Champion who is involved with the project before the software is even selected.  Nothing sells a physician like another physician.  This is also why it is important to have organization-wide support.  The IS staff will have zero authority over physicians.  Therefore, if the organization is moving with the project a physician has to fight against the organization and not just the IS department.

The last major hurdle to mention directly relates to implementing ambulatory EMRs. Numerous organizations get into trouble when they treat the implementation of their clinics as an “add-on” to what already exists in the hospital EMR.  Any standards or system protocol that are already in place should be re-evaluated as the clinics come up on-line.  This is especially important when considering ordering.  Parameters and settings regarding future orders and patient accounts that make sense in a hospital setting sometimes just don’t work in an ambulatory setting.  Ideally it would be nice to have the global view before any portion of an EMR is implemented, but a re-evaluation will suffice.

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