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March/April 2009—Related Articles

Electronic Health Care Advances, Physician Frustration Grows
Carrie Weimar

Cornerstone Health Care: From Paper to Digital in Record Time
Grace Emerson Terrell, MD, MMM, CPE, FACP, FACPE and Tim Terrell

Going All-Digital is Easier Said Than Done
Carrie Weimar

Complete survey results

Electronic Medical Records 2009 Response
Percent   Count
2004 Response
Percent   Count
No development under way 5.9% 55 15.1% 237
Researching/Planning 17.5% 163 33.3% 521
Bidding 2.4% 22 4.5% 70
Testing 9.9% 93 14.0% 220
Already in use 64.5% 602 33.1% 518


Computerized Physician Order Entry (CPOE) 2009 Response
Percent   Count
2004 Response
Percent   Count
No development under way 13.7% 127 22.4% 349
Researching/Planning 26.2% 243 33.8% 527
Bidding 2.5% 23 4.6% 72
Testing 13.9% 129 15.8% 247
Already in use 43.8% 407 23.3% 364


Pharmaceutical Bar Coding 2009 Response
Percent   Count
2004 Response
Percent   Count
No development under way 30.6% 277 36.7% 559
Researching/Planning 20.7% 187 31.4% 479
Bidding 1.7% 15 2.8% 43
Testing 8.6% 78 8.3% 126
Already in use 38.4% 347 20.7% 316


Electronic Prescriptions 2009 Response
Percent   Count
2004 Response
Percent   Count
No development under way 15.0% 139 34.0% 524
Researching/Planning 27.1% 250 33.7% 518
Bidding 2.8% 26 1.9% 29
Testing 12.9% 119 9.4% 145
Already in use 42.2% 390 20.9% 322


Patient Electronic Communication
(including patient e-mail and online patient communication)
2009 Response
Percent   Count
2004 Response
Percent   Count
No development under way 38.8% 359 44.0% 680
Researching/Planning 30.2% 280 28.2% 437
Bidding 0.8% 7 .8% 13
Testing 10.6% 98 8.7% 134
Already in use 19.7% 182 18.2% 282


Personal Digital Assistants (PDAs) for Clinical Use 2009 Response
Percent   Count
2004 Response
Percent   Count
No development under way 42.2% 388 27.3% 421
Researching/Planning 16.1% 148 24.8% 383
Bidding 0.8% 7 1.3% 20
Testing 7.3% 67 10.2% 158
Already in use 33.7% 310 36.2% 559


In general, what is the PRIMARY reason why you currently use or plan to implement new health care information technologies. 2009 Response
Percent   Count
2004 Response
Percent   Count
Wave of the future, trying to stay current 21.2% 194 11.1% 167
Reduced liability and reduced medical errors 32.9% 301 42.5% 638
Accurate recordkeeping 28.1% 257 28.7% 431
High return on investment 3.6% 33 6.3% 95
View Other 14.1% 129 11.3% 170
Not planned
DoD mandate
VA mandate
NO plans. I work for city health department
quality and safety
all of the above:efficiencies, quality, safety, compliance with regulation
No rational reason. The hospital simply wants to do it.
pay for performance incentives
communication
quality
access of health record possibilities
I do not plan - it is impossible to treapts effic. -too much garbage.
Have you ever tried to interpret a typical six page ER note?
Records more readily accessible.
forced to do so by government authority
paper record access and data retrieval inadequate
involved in using to research cost effectiveness
Better access to information in the future to improve care
ran out of space for med records switched to e
Improved patient safety and value
all of the above
Multiple
Quality and efficiency gains
bad handwriting
expected
Patient Safety
improve quality
only way to be able to document increasingly demanding critera
for quality measures and reimbursement
improved overall efficiency and access
Quality improvement data mining activities
increased efficiency
improve quality, clinical outcomes and integration/access to information
pushed to it
Mandated by the government
Real-time data sharing and availability
pressure to do this
Market differentiation, medical home project
Retired and doing missionary work -
not much call for a computer on a boat on the Amazon
decision made 11 yrs ago on basis of
connecting a 250 person physician group together
data management
keeping up with govt. mandates
EMR mandated by CMS by 2010.
Efficiency, quality, access
forced by HMO i work for
clinical quality
Improved data collection on quality metrics
More efficient and more effective record
reduce expenses
usaf directives
Presidential directive
improve quality and safety
improve quality and pt safety
Improve patient care
To track outcomes over time
A major tool to drive quality and safety
Being forced to use by government mandate
avoid lost records between locations
tools to drive quality, safety, and efficiency
Govt enforcement
record portability and survelliance
Rapid access of information; lab and x-ray results, reports and old records.
Tracking health progress of my patients; serial labs, blood pressures and weight.
Health maintenance reminders for providers and patients.
Faster and easier documentation.
Faster and more accurate coding.
Ready access to patient educational materials;
pictures, diagrams and handouts
employer
NO PRIVATE PRACTICE
Better patient care
Improve communication and access to medical record
Improved quality
I don't plan to adopt this due to cost and lack of standardization and interoperability
bad choice
It's better for patient safety and quality of care.
Ability to standarize according to evidence based practice
Forced to by regulators.
Government mandate
improved quality
Develop an insurance product
Gateway to performance measurement efficiency
Not applicable
It will soon be required of all systems
improved productivity
payer issues-CMS
required
required by my employer
Efficiency, labor saving
efficiency and quality
quality & patient safety
improved reliability to provide indicated care
Forced to by Higher Leadership
Lean transformation oh healthcare
convenience
quality and efficiency
It is just simpler, saves time, reduced support staff since paperless
Saving Trees
Better quality of care
The system are not ready. Too slow, too much garbage created, cannot follow pts easily
unclear reason or strategy
Collaborative medical care
Improving quality of care
Perceived mandate
all of the above
office effieciency
Operational improvements through availability of information.
Convenience, ease of retrieval of records, coordination of care
Improved quality of care
required of residency training programs
best way to improve care and margin
being proactive
requirements, and 'wave of the future"
gov't edict
the right thing to do
Improve quality of care, use for contracting.
quality and safety
Better Access to information and integration of care
improved patient care
More widely available clinical information
Patient safety
Fully integrated, comprehensive patient care record
patient safety
Better all-around patient care
Essential to provide best quality care
organization and accounting
effiency and decreased costs
No choice.
access to records anywhere, anytime for best patient care
not sure
improved clinical outcomes
We would like to be slow adopters, so we really aren't planning this for now.
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What is the PRIMARY obstacle that your organization encounters when implementing -- or attempting to implement -- new information technologies. 2009 Response
Percent   Count
2004 Response
Percent   Count
Lack of support or buy-in from physicians and other medical staff 19.6% 178 17.9% 267
Too difficult to train staff to use technology 4.1% 37 3.4% 51
Lack of money/resources to implement technology 40.9% 372 45.9% 685
Little or no return on investment 6.5% 59 4.0% 60
Too difficult to integrate with other computer systems already in use 11.9% 108 13.8% 206
Haven't seen the right system yet 4.3% 39 7.0% 105
View Other 12.8% 116 8.0% 119
significant reduction in staff productivity if system implemented
Data insecure. Forced to become a covered entity under HIPAA if used.
Execs don't "get" how much effort this takes.
more complex than expected
not ready for prime time
No obstacle, implementation on going
Need a paradyne shift. Currently data in paradyne - need central data out without garbage created to max billing. Systems currently maximize billing, reduntantly added to each new encounter.
funding, lack of
Poor interface btw physician and technology
systems are still primitive
decreased productivity without return on investment
none
our administrator hired and idiot for our internet person
not applicable
n/a
billing integration to patient point of service . eventulally overcome
slows work flow
Current IT products difficult to use
Our organization is completely committed to emplement a fully integrated electronic interface with EHR, patient communication etc. Money and resouces are the main rate limiters
unable to get a sufficiently user friendly system from the software provider.
Out of sync with Strategic plan or Business plan
No real obstacle
No problem
hospital admin and IT too cheap and lazy
Time to implement across a large system
being able to identify the incremental ROI on new IT initiatives
Our Organization has the competitive edge in I.T. implementation, and we have relatively no barriers to its implementation.
Company selected did not live up to their promises, thus implimentation has been delayed, expensive, and very frustrating, but we will eventually succeed.
Change management
No issues. Very forward thinking
too expensive
No major obstacles to date
Not appropriate to my setting
More Time Consuming
have done
Cerner difficult to learn
Some physician resistance
No obstacles here!
moving ahead, but alot of work involved in the process.
hideously cumbersome/inefficient
rolling out to 400 providers + support staff
Limited IT staff
EMR in place not user friendly and slow
poor quality software in existance
The systems do not deliver as promised
Problems with communication
The first 3 categories each varying with the issue and bureaucracy
Trying to bring together a 14 hospital system into one computer system that will support all areas of medicine is an oveerwhelming task that will take years to accomplish.
System we have is does not work!
IT that is slow and outdated
Too expensive and not user friendly (yet)
cost
slows patient care
NO PRIVATE PRACTICE
Physicians and staff resist the change in job descriptions enabled and required by new workflow
Most systems are too expensive; we are now building a system ourselves with the risk that the project may become too large to handle for us
Attempt to maximize system investments in IT while creating interfaces for disparate systems.
Even with the best system, it still has many limitation in the clinical world.
lack of accepted industry standards, esp for CMS
We're already 100% electronic
This is re-configuring all health care delivery in the hospital. It has been challenging, but the physicians are developing a product line for EPIC! We are completley reordering health care delivery to conform to the EHR (to the documentation system.)
organization selected bad emr
ROI is terrible as there is little improvement in time saved
Time and energy
poor computer technology
difficulty in getting all of the staging correct
system attempted to develop its own electronics record system ~5 yrs ago but just scrapped it
It dose not live up to the promise. Too difficult to use in daily work flow, too difficult to enter data and reteive meaninful "information". Interface problems with other data systems and difficulty in use has created new types of medical errors and challenges.
no problem
I'm in solo practice, the biggest barrier was just the extra work of the transition
not ready for prime time. Those advocating have never received a five pt ER not with no way to fascertain why the pt was there and what was done
limitations of current software
lack of leadership
poor IT support from vendor
No special problem currently
IT systems, while more accurate in recordkeeping, slows the flow of clinical work
Current ROI decrease due to current economic conditions
difficult to change
Lack of resources to keep up with demand
All of the above
LACK OF RESOURCES TO TRAIN NEW HIRES TO ADEQUATELY USE THE SYSTEM
Nursing not on board
already have system
entrenchment in old systems
I am retired and do now work for an organization
Already using
money is challenging
All of the above, except lack of support from medical staff
No Resistance-Moving along well
standardization required to interface, and document.
Requires additional time per encounter
Lack of interoperable EHRs
reduction in productivity
Huge investment- being done gradually
Integrating with system, avaialbility of IS support
already using
Information systems department resistant to doing any work
most systems still too complex, archaic, difficult to use
many issues most were technical
incentives are poorly aligned to allow any significant ROI
Decreased productivity.
poor products, but hospitals have already paid millions and are unwilling to dump poor systems.
TIME and MONEY.
difficulty in integrating physician workflow
we are not the highest priority in our health system
slows down the practitioner
In alpha and beta testing
physician agreement around platform
Lack of support from CEO
High start-up costs, and lack of demonstrable portability between vendorsinappropriate planning of implementation.......needs more MD/staff input and better planning before going live
Sysrtems are not designed th way we take care of patients. Therefore the practitioner must change their approach to patient care to utilize the EMR. Also the EMRs do not integrate with other systems very well eg lab, radiology. Niche systems persist in cath lab and in the OR
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Where does your organization stand when it comes to physician involvement in health care technology decision making? 2009 Response
Percent   Count
2004 Response
Percent   Count
Physicians have little or no involvement in technology decisions 16.6% 152 21.0% 315
One physician works part-time on technology issues 31.9% 292 28.8% 432
Full-time physician technology officer 12.2% 112 10.3% 154
More than 1 full-time physician working on technology 20.7% 189 18.7% 280
View Other 18.6% 170 21.2% 318
Ad hoc workgroups are set up
ONE PARTTIME SALARIED AND SEVERAL NONREIMBURSED MD COMMITTEE MEMEBERS
CEO, CMO trained computer scientist
many physician involved at HQ level, no requirement of involvement at local level
One full time IT medical director, several part-time physician champions
considerable physician input
Volunteer physician committee
Physician input welcome but not reimbursed
committe work 3-4 physicians
Group and others involved
Pysician input through committee structure
minimal physician involvement
combination of part time physician, physician advisory committee, physician services/trainer involvement
Huge organization with inexperienced physicians having input.
physicians very ivolved but do not work primarily on IT
several physicians work on this part time
Various degrees of involvovment from medical staff members
A very large system with lots of physican involvement
Med Staff physicians work with hospital IT administration
one part-time IT physician with assistance from faculty and private practice docs as well as house staff.
Physicians have input on a committee basis
Two physicians, both spend some time on tech issues
Multiple part-time physician engagement
M.D. advisory team
involved as practice Board of Directors
consulting
many physicians with some input
clinician task force(includes nursing, physicians, pharmacy, etc)
medical staff advisory committee
physician oversight as time permits
Committe-includes physicians
multiple physicians volunteer their time on IT committee
Interested physicians spear head the ideas and implimentation, the others follow along, some with reservation
md involvement as stake holders on voluntary basis
Several part-time physicians
We don't have a physician "position" but there is significant physician input into technology decision making.
CEO is MD
several physicians with part time responsibility to IT issues
volunteers meet quarterly
Medical staff is consulted before final decisions are made.
Part time clinical informaticist. We are expanding the role.
Organizational structure does not require
We have a team with a lead physician champion
one doc paid on a per diem basis
CMO's and committees
Physicians involved in decisions
IT manager fte
one primary executive sponsor, but not full time and multiple other physician champions
intermittent physician input
Physician Committee Oversees
3 part-time physicians; one ambulatory; 2 inpatient
Several doc work part-time on technology issues
collaborative input from all physicians
Medical Informatics Cmte.
Involvement from various physicians
EMR Committee
volunteer physicians are used
Three physicians work part-time on technology issues
Multiple physicians work part time
Have Chief Medical Information officer
several part-time
volunteer group of physicians, IT staff, transcription staff, NPs and Medical Assistants
Several physicians involved part-time on technology issues.
We have a CMIO, a full staff and numerous physician/nurse committees that work tirelessly in this area.
Physician/Management jointly evaluating and implementing
Our organization is physician owned and physician led. The partners are intimately involved in all of the steps in the adoption of IT decisions.
3 Physicians part-time on EMR task force
multiple part time physician involvement
multiple physicians input through volunteer computer committee
Multiple MD's provided input
Many physicians involved with a substantial amount of time, but no MD with >50% time on IT.
Physicians have input, but no standing position
Independent medical staff phhysicians on local and system IT committees
NO PRIVATE PRACTICE
Many Physicians very involved in every step of process
volunteer committees
1 MD part time;input from many others
Physician CMIO - part time - with other interested physician champions
volunteer physicians on EMR committees
many physicians working part time on technology issues
Multiple inputs from multiple sections and medical staff executive committee, plus a physician working part-time on technology issues
steering committee with physicians
Multiple physicians have input into the decisions
Two physicians volunteer on IT committee (very part time)
private practice, all partners decide
many part time developing reasonableness of the technology
volunteer physician committees
many involved part time to some degree
unknown
physician advisory committee
solo practice
Multiple physicians and nurses on dselctin committee
many physicians involved
active involvment
Physicians have a chance to evaluate
multiple praciticng physicians devoting part of their time
physician input is periodically requested but there is no physician technology officer
committee
many physician envolved
medical staff leadership involved
na
PHYSICIAN COMMITTEE
Faculty always has significant input
physician board decides
Physicians are consulted by hospital administration
I make the decisions
I am a solo family doc. It is my choice.
Practice partners manage IT
SEVERAL WITH VARYING LEVELS OF EXPERTISE AND ALL WITH INPUT.
Many physicians weigh in on decisions
CMIO just left institution
Our organization has 325 clinics, I suspect that there is plenty of Physician involvement.
Multiple physicians work part-time
physician advisory group
physician IT task force
each physician office makes its own decisions
Practicing physician involvement
solo practice
IT department
Several physicians share
Physicians are queried and invited to participate in generalized strategic planning and reviewing products.
one doc spends ~ 80% of his time on this, and there is a physcian advisory group
Physicians involved at most steps
Physicians have various degrees of involvement on technology issues,varaible time commitment.
multiple MDs working part time, some inpatient,some outpatient
solo consulting practice
MORE THAN 1 PHYSICIAN WORKING PART TIME ON TECHNOLOGY ISSUES
md involved with team manager etc.
Physicians involved in national VA EMR applications.
Several docs provide input
IT team working constantly with physicians
unclear--hospital owned practice. Neither myself nor my partner have much if any input
I do not work for an organizaton
Multiple docs
IT committee and few interested physicians in planning and input process
full time dept at the hospital
Several physicians part time
Physician team in developing standards, with one part-time Physician leader
Physicians advise on each new implementation
have IT office, non-physician
Physicians are involved at all levels
Voluntary physician involvement at multiple levels
PA is IT leader
physician input solicited
Numerous part-time physician involvement
We are looking for a full time physician and currently have several physicians involved part time.
Multiple physicianswith part time input
CMO involved on the IS Steering Cmte; also have a Physician Informatics Cmte
solo practice/ MDs should be involved
one physician champion and physician advisory council involvement, positions unpaid and voluntary
Physicians can add their input as needed
IT person in group advises administration and clinical staff
Medical Directors are on the IT Steering Committee
multiple physicians work part-time on technology decisions
technology committee welcomes physician input
Physician inout sought on a product by product basis.
one part time physician in official position plus others involved on voluntary basis
committee
Many physicians part of planning
Full time physician technology officer with no/limited input from full time clinical physicians
Committe involvement, no one paid until we go to CPOE, then multiple ones (2.5 FTE)
IT committe made of physicians
Four part-time physicians totalling 2 FTE
physicians asked for input
A part-time physician leader for informatics and operational physician leaders with responsibility as well
MDs as advisory roles
physicians are part of committees
Multiple part-time physicians and an IT Physician Advisory Council
no dedicated position but many physicians advise us
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Survey comments

Physician buy in is good but frustration is high with slowness of the systme and the change in work flow.
3rd week of EPIC and better than I expected
I used EMR when in practice in another state but I am now a hospital employee and they would not allow me to use the system I already have. I went back to paper charts.
We have not initiated CPO yet because of concern with others experiences.
It's just a very expensive thing to do including all the time it takes to train everyone. Many benefits, but many drawbacks too.
With my specialty in hematology /oncology,developing a specific EMR or EHR system for oncology practices has been very labor intensive with a lot of time commitment and ongoing expenses in a time of diminishing reimbursement. I certainly would not go back to paper charts , but hope for incentives to continue with the current expenses in this new technology with all the added overhead.
Still to expensive and few resources for small practices like mine (4 physicians)
A tremendous amount of money being spent over the years at various hospitals. No system exists that does it well. fortunes spent on implementation of system that is inadequate and no monies left for improvement of system. i believe EMR are necessary eventually, but still need to develop system satisfactory for all---patients, nurses, docs, pharmacy.
Regarding EMR, we only have inpatient nursing and full ED. We are still exploring full inpatient EMR to include physicians.
Make sure to involve key physicians in decision making. Change policies to ensure ongoing success. Celebrate
We are at the mercy of multiple vendors and lack of standardization, without extra capital to spare. This is a no-win situation and results are mixed or certainly less than impressive in regard to the enhancement of quality.
Both our clinic and our hospital are completely digital and share the same EMR across inpt/outpt environments, which has tremendous power to improve care coordination and reduce errors.
As VPMA I do have some input in tech decisison but not enought time to really devote to it. Out organnization is considering developing a Chief Medical Infomration officer role for 2009.
I love it, I can access my patients' charts from home or on vacation
I am not of the generation of computer technology and hence had to step up my learning curve to embrace EMRs. But since being on EMRS going on 4 years now, I feel I am more organized, complete, and consistently clear on my communication with patients. Sometimes the time doesn't exist to cover all the information about disease - but at the press of a button I can print all that I want to share and have the patient review at a less stressful time than in the office. Even as a patient I appreciate printed info from my doctor that allows me to review at a another time.
i will never go back to written records,investment payed off already,better charts and documentation
VA is very well developed in clinical IT utilization.
High level IT solutions are critical for providing quality care and integrating care across settings and specialities. Hospitals must invest adequate dollars.
I recently retired from military medicine (Air Force) and we were moving at a reasonable pace toward EMR and had implemented physician ordering for all our pharmacies. The cost is, I feel, just too high for most private institutions except the very large ones. Most community hospitals and associated physican practices just cannot invest in the forseeable future.
Can't imagine practicing medicine without an electronic EMR. It improves safety for our patients and allows our providers to work from more places.
Big organizations are not nimble and do not implement change easily; once you have invested time and energy in a system, no matter how clunky, it is difficult to consider changing.
I worked as a community pediatrician, using the Epic electronic medical record for the past 8 years. Now I am at Cincinnati Children's Hospital Medical Center, working on the implementation of Epic hospital wide. The disconnect between what the EHR can deliver and the expectations of the institution, plus the reluctance on the part of staff to change workflow create interesting challenges.
I am working to promote communication in health care using an innovative approach to information management (with Dr. Koop).
my answers are referring to our practice and not a specific institution like a hospital
We have used EPIC for over 11 years and it has been a great system. We are currently focused on the patient interface functionalities... secure messaging, patient self-appointing, access to lab results and chart information.
As much a spossible, it is advisable to implement the entire process at one time. Piecemeal implemenation leads to poor physician particip[ation and waning of interests.
Too many people talk about EMR but very few people know what they are and how much they cost. There is a very limited supply in the market and also total lack of interface.
It has reduced our productivity by 30%. Patient satisfaction scores are going lower due to longer wait times. In addition to the above, we have had to add to staff in all areas just to not reduce our efficiency to less than 30%. We are using EPIC.
I have certainly fought the ideas in the past because this is just a lot "change". However, the organization I work within is dedicated to being a pioneer in the arenas that promote safety and effective communication. Thus, we have become a national leader in EMR and information technology.
Standardization of healthcare data and open architectures are vital.
at the large group practice that i founded and worked in for 34 years and served as medical director, i did help implement a EMR which includes electronic prescribing.
State of the art in the industry also has quite a way to go to become fully mainstream.
The money isn't in aquisition, it is in implementation (design, training, testing, etc.).
I work both in aprivate practice setting where we have no EMR, and as medical Director for IT where we have a large EMR with expanding CPOE. The lack of office EMR is expense and the inefficiency of start-up.
Consumes huge amounts of resources--software, hardware, training. Lack of common language and lack of file standardizationare also barriers. Each software upgrade or new software requires extensive testing, program rewrites of interfacing equipment and software.
We have gone live with our first small clinic, 10 days ago. We will be rolling out our 7 other clinics over the next 6 months. 80 Physicians, with lots of prework and planning for a year before roll-out. First roll-out very successful, with 2 0f 3 Docs now at usual productivity. Preloading of charts and familiarity of EMR absolutely essential to success, and involves the entire clinic, as workflow is greatly altered at the advent of the EMR.
Apart from costs of the hardware and software, there is a tremendous cost in staff time and revenue when switching from paper to electronic charts. This is especially true when there are decades of medical records to convert. There needs to be more leadership in developing regional health information organizations (RHIO) to increase the utility of the EMR.
Technology is the wave of the future but little input from "knowledgable" "practicing" both surgical and non surgical physicians is lacking. Mandating and implimenting technology by non practicing physicians and non medical administrators who forget that time spent with patients is more important with spending 90% of the time filling out paper work so the "beancounters" to look over your shoulder.
It is still in process, but is already providing a great benefit to the organization.
system interoperability remains the largest barrier to broader implementation
Sutter Health is implementing EMR system wide over the next 6 years. 1 billion $ investment
Dumb study
We started implimenting an EMR with Cerner but this has been put on hold indefinitely due to cost constraints with our MBO
We have been using the EMR since 2002 and could not have grown without it.
Our adoption of the EMR and maintaining competence (perhaps even expertise), has helped catalyzed the development and pilot testing of an early Regional Health Information Organization (RHIO) system w/BC-BS and State Medicaid.
*cpoe is still vaporware as far as i've seen *pda's, notebook computers, wireless networks...all a maintenance and troubleshooting morass... *when will vendors agree on a standard interface????
Planning to transition from Meditech Magic Office to Meditech Client Server 6.0; target date January 2011
Our institution implemented 20 Cerner solutions including CPOE, physician documentation, care mobie and others in a big bang approach. I was the physician champion and the medical staff project manager for the implementation. I am interested in physician issues and if you would like to talk about these issues further or would like to collaborate on this survey, please e mail me. We started the process in third quarter of 2007 and went live on 8th September 2008. There is much more information that I can provide than what is possible to be included on this survey. Thank you very much and looking forward to collaborating or seeing the survey results.
Some physicians--young ones included--fight the process of implementation tooth-&-nail. Do they think we have any choice about EMR adoption, or that they, uniquely, can ignore the trend?
One reason I hear for the lack of adption is that the benefits flow mostly to others. Another problem is the lack of practice redesign before the electronic tools are put in. It is like putting a jet engine on a horse's back and expecting the horse to go faster.
It is a world where 50% of the physicians embrace it and anticipate great rewards, while the other 50% think it's overpriced, time consuming, immature, and disappointing.
EMR is the way to go: Better documentation, cheaper in long run, helps standards of care and can get paid quicker
Minnesota State Operated Services (behavioral and chemical health services) has been developing an electronic health record for over 7 years. We are working with NetSmart which developed AVATAR and the Clinical Work Station. Progress has been slow because much customization was needed. Lack of programming resources has been a major source of frustration.
More physicians are interested in using the technology than ever before, but do not want to share in the cost involved with purchashing or implementing it.
I have answered for my part-time (volunteer) position as a surgeon at a DoD hospital. My full-time employment at a managed care organization does not involve documentation in medical records or prescribing.
It isn't so much the difficulty training people - it's that docs do not yet see multiple sources of value coming back to them. A comment I rarely see made about EMRs is that first and foremost, they must be easily useful as medical records that document longitudinal care in a manner understandable by physicians both inside and outside the organization. We need a better balance between the database-driven and the narrative-driven approaches. A lot of these systems were designed with little prior understanding of physician workflow. EMRs ideally will change that workflow, but right now the required shift is too radical in some cases.
we would appreciate consultants to find the right system that would fit our needs
I have been involved in computer programming since 1971. The products currently available are poor. The industry should use physicians, such as myself, with computer experience to help develop products. As it is the hospitals and practices buy in and tell the physicians what they will use. The result is poor.
The hospital within our system is doing these things. Lots of resources are expended to accomplish the task.
The question "Have you implemented an EMR" is not easy to answer. 3 of our 7 sites have, 4 have not. Physician reluctance is high. bandwidth speed at surrounding sites is an issue etc...
Biggest obstacle to a system wide change is private office integration. Too many non compatible systems and no money to implement.
redesigning workflow is a major obstacle to implementation but less so than financial issues. physicians will not embrace the technology until and unless it will enhance THEIR time, efficiency, and productivity or unless the incentives outweigh the disincentives at the physician level
We are the 3rd hospital in 13 of our organization to implement the EHR, with mandatory use by 4/1/09. Having the right physicians on your steering committee is essential for implementation, especially with CPOE.
Safety, Quality, and Efficiency continue to be the guidance of our adoption of clinical IT (CPOE, EMR, Portal). Difficult to track ROI with tools currently available. IT is only a tool that if used for improvements in Safety, Quality, and Efficiency in care delivery can be very powerful. Can not overstate the importance of engaged physician leadership on the journey.
Survey confusing regarding office vs system questions and answers. Tried to run down the middle. Happy to discuss.
IT support is my primary problem to implement new technology. My physician and administrative staff has been requesting an EMR for 4 years. We are continually met with the response from IT, "it's too hard to integrate the systems, we don't have the resources". I find it ironic that we continue to meet increased patient demand - efficiency and care measures - while trying to limp along with IT systems that are woefully inadequate. Those in charge of IT decisions are not involved in clinical care and are not away of the front line user problems/issues. When these issues are brought forward, the IT department appears to carry more weight than patient clinical care (probably because of the lack of commitment to resources, a.k.a. money.
Cost of Capital and cash flow issues have chilled future budget plans...
Technology is advancing and needed. Computer systems need to be unified and adepted to this high informational technology.
Difficult to get physicians engaged and less skeptical. EMR needs to work well for the doctors and not get in the way of providing quality care.
We are a 220 physician practice building our own EMR. We don't like any vendor product.
I have worked in the VA system which is heavily EMR driven (albeit arcane), and at Duke where the psychiatric EMR was developed during my tenure by Ken Gersing, M.D. when EMR's were largely unheard of. In my current setting, slow-adoption is a sensible approach, as startup costs for a truly portable system remain exorbitant, and a single standard has not emerged.
Need to better define value proposition for EHR/CPOE for physicians.
Survey was difficult: we are in the process of starting EMR in our offices-1 is fully operational, 15-20 offices to go. So, are we operational, or testing? Likewise, many different physicians have been involved in new technologies-no one person, so I'm not really sure how many FTEs that is.
We have just implement our second generation EMR. We have used Eclipsys for ~15 years. Great when it first came out, but is no longer state of the Art. Over the past year we have implemented EPIC in almost all outpatient areas (160,000 visits per year) and last month rolled out the inpatient version house-wide with pharmacy. EPIC is better than Eclipsys, but no system is fantastic.
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