EHRs Fix Everything – and Nine Other Myths

Realistic expectations can help your conversion to electronic health records succeed.

David E. Trachtenbarg, March 2007 AAFP

Two physician groups implement the same electronic health record (EHR) system. One improves quality of care and productivity and saves thousands of dollars. The other reports more errors, loses efficiency and teeters toward bankruptcy. What’s the difference, and how can other EHR users achieve the results of the more successful group?

Having realistic expectations about what EHRs will do for your practice and how they’ll work is a key to effectively selecting and implementing an EHR system, but too many groups set themselves up for failure by beginning without a clear sense of what they will achieve. This article offers suggestions for dealing with 10 common misconceptions that lead physicians off course on the EHR journey. It is based on my experience purchasing and implementing an EHR system for a 120-provider, 30-site group, as well as my discussions with physicians from more than 50 organizations about their potential EHR purchases. It includes a few references to EHR studies, but, like the authors of one literature review, I found that information on EHR use in primary care was a “descriptive feast but an evaluative famine.”1

Myth 1 – A new EHR system will fix everything

Some groups want to purchase an EHR system to help transform their organization and take it to the next level, but they may be expecting too much. In the book Good to Great, author Jim Collins observed that technology works as an “accelerator of momentum, not as a creator.”2

An EHR will not fix organizational problems, and it does not guarantee improved efficiency and quality. In fact, installing software is just one part of a journey toward improved efficiency and quality.

Fact: An EHR system is not a panacea. The transition will create new problems in addition to solving old problems. Think carefully about whether your organization is stable enough to handle the challenges.

Myth 2 – Brand A is the best

I’ve met physicians who would never seek out an expert on hypertension to ask, “What is the best drug for hypertension?” yet they search high and low for tech experts to ask, “What is the best EHR software?” Just as it is for hypertensive drugs, the correct answer for EHR software is, “It depends.”

Fact: There is no perfect software. You should expect your EHR software to do some things well, some things so-so and other things not at all, and what works well for one group may not work for another. The following three considerations will help guide you:

1. Determine your vision. Is it that better documentation will enable you to maximize billing or achieve outstanding disease management or something else? When my group was thinking about which software to buy, we summarized our vision for the EHR system in the phrase “Networked physicians, shared care.” Starting from that vision, we tried to purchase software with features that could promote communication with other physicians and integration with other hospital systems.

2. Determine the scope of the project. For example, are you a solo physician in a single office, or will the project involve many physicians located at multiple sites? Some systems are better for small practices, others for larger groups.

3. Determine what other systems need connections to the EHR. Consult with information technology professionals to make sure the software you choose will work well with your other systems.

Myth 3 – Our software needs to work the way we currently work

After one consultant advised my group to produce the best paper record possible and then convert it into an electronic record, one of our physicians commented, “So we should make the best horse and buggy possible and then use it to create an automobile?” We passed on the consultant’s system, though the exchange raised an important point: To maximize the benefits of an EHR system, you need to take advantage of its positive aspects by changing your workflow to accommodate them. It will not be possible to continue doing business as usual.

Fact: An electronic record is not a paper record on the computer, and you will maximize your efficiency only by making significant changes in your workflow. Expect to work differently to make the most of the EHR system’s advantages as well as overcome its disadvantages compared to paper (yes, you will find some).

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