5 Healthcare Leaders Discuss the Challenges of EMR Adoption, Implementation

Datamark, a provider of digital mailroom, data entry and document processing services for Fortune 500 companies, and Creative Healthcare, a provider of performance improvement solutions, recently held a roundtable on electronic medical record adoption and its challenges.

Here are edited excerpts from the group's discussion, where healthcare leaders talked about where their organizations are in the process of implementing EHRs as well as the challenges they have faced. They also made suggestions for EHR improvement.

Excerpts have been edited for clarity and continuity.

Jonathan Bauer, CIO, Somerset (Pa.) Hospital: Along with the hospital, we have about 25 providers in different practices. We will be meeting meaningful use stage 1 and are preparing for stage 2. We are upgrading applications to prepare for stage 2. We are on the Paragon system. For outpatient practices we use Allscripts.

The biggest challenge with implementing and using EHRs has been that it has resulted in a different workflow for the physician. They are documenting more information than in the past, and documenting more in a new system has been difficult for them. We use a hybrid EHR system that allows physicians to go back and forth between electronic records and paper. But some may continue using only paper until asked to switch back. We keep the electronic copies of patient records for 26 years. The hard copies are scanned into the system and a month later they are shredded. Within two days, the patient records are available online.

The main request that physicians have is that they want a scribe. They want to do what they have done for years and have someone else document in the system. Part of the reason for this is the lack of familiarity with the system and the fact that there is more documentation. However, ultimately, it is about improving the health of the population. We are taking EHR data and mining it. We are looking at it and trying to decide how to move forward.

Kevin J. Helmrick, MD, CMIO, Methodist Healthcare (San Antonio):
Methodist Healthcare, in 2012, implemented the full EHR system in the eight facilities here in San Antonio. Most of our care is acute-care. The primary modules are electronic results reviewing, provider documentation, CPOE and order sets to support the CPOE. We have 1,500 active providers that use our hospital, and training and outreach has been provided to nearly all of them.

This is a major transition for any healthcare organization. It was a disruptive and transformative change for our physicians. Some provider concerns were ease-of-use of EHR software and impact on productivity and workflow in the hospital. Moving to EHRs was not an issue of 'if;' it was an issue of 'when.'  We find that while the basic EHR functionality is working, it is causing some difficulty and pain for our physicians, especially because physicians have to learn how to use the EHRs in their practices as well as in the hospitals. User interfaces are not working well — this is a well-established issue across the industry. The physicians also have to sometimes operate in a dual world of processes on paper and processes on EHRs.

I'd like to see our EHRs support clinical workflow rather than just capture data. One way to improve user interfaces is to involve experienced physicians in the process. There are also opportunities to improve documentation. It is difficult to change our healthcare systems because of the complexity of the systems.

Theron Pappas, CIO, Holy Family Health (Manitowoc, Wis.): We started the process of EHR implementation in the early '90s. We have about 10 clinics, one hospital facility and approximately 80 employed physicians. We have attested for meaningful use stage 1 last year and are preparing for stage 2. The main feedback we get from our physicians is that the electronic processes take time away from the processes that can't be done on an EHR. There has also been a dip in productivity. We don't have too many issues; however, usability is one. We are using an older system and its functions look antiquated. But while we are on the path to meaningful use, it is difficult to stop and overhaul the system.

One way of improving the user experience is asking patients to fill in information themselves. A lot of the things we gather are things that patients could fill out themselves, either through portals before they visit or a little kiosk when they come into the office. We are currently committing our nurses to spending 15 minutes of patient intake when it shouldn't take that long. Also, if the patient gives the answer than that must be the correct answer. There will be no question of whether I or the nurses took it down correctly or not.

William Spooner, Senior Vice President and CIO, Sharp Healthcare (San Diego): We use Cerner for our hospital system. We achieved stage 1 meaningful use in 2012 and collected the money. We are now looking forward to stage 2. As we look forward to stage 2, we want to increase patient engagement — how do we get more people using our portal? We imported the paper documentation years ago, so now the patient sees no paper chart when they go into the doctor's office.

We have to accept that change comes gradually, and most would not want to go back to paper. We do see improvements in every one of our products. While we are trying to make the systems better we also have to make sure we are changing the processes to align better. But we have to look at the glass as being half full.

One of the biggest challenges we are facing is the aggressive meaningful use program we are on. We are seeing pushback around the industry. It takes a lot of time to define, create and refine IT and these two year increments are really aggressive especially when we are trying to create a good product.

Mike Williams, CIO, FHN Healthcare (Freeport, Ill.): Fifty-five percent of our providers are up on the EMR within their practices. Specifically, what that contains is messaging, data input for demographics and progress documentation, which is based off template based documentation. The remaining 45 percent are on some version of EMR to meet meaningful use phase 1 requirements. We have our experience as EMR light for the 45 percent and EMR full for the other 55 percent. We have two different phases for our EMR experience. We also use one vendor for both inpatient and outpatient services. 

Datamark and Creative Healthcare have also released a whitepaper based on the discussion.

More Articles on EHR Adoption:

Study: EHR Adoption by Family Physicians has Doubled Since 2005
44% of Hospitals Had EHRs in 2012
Physicians May Lose Over $40,000 in 5 Years After EHR Adoption

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