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What Drives Non-Acceptance of EMRs?

posted Feb-19-2015

i-dont-want-to-p.com-87781411I recently read a report stating that nearly half of all physicians in America still rely on paper records, and I was astounded to know that the number was so high.  All of the doctors I go to have EMR/EHR, many that integrate with the local hospital and other providers within the system.  The great thing with this kind of integrated technology is that all of my doctors, from my dermatologist to my family doctor have access to the same information about me, and I only had to provide my details one time, to one doctor.  It’s certainly saved me lots of time, since I recently moved and had to get established with all new doctors.  I can also log into the patient portal to access my records, request a prescription refill or an appointment, and a host of other time saving conveniences.  So what’s not to like about Electronic Medical Records?

Why Some Docs Don’t Want an EHR

Many of the paper-based doctors just don’t think that there are enough advantages to EHR to spend the money and the time required for implementation.  But, we wonder if it might also be a basic resistance to change.  Physicians are a conservative lot.  And, especially for small practice physicians, the philosophy seems to be that as long as it works, there’s no need to change.  We might point out that horses can still provide transportation, but we assume that most of these docs use an automobile to get around.

While health industry leaders encourage doctors to join forces and merge into larger groups or integrate with hospitals in order to achieve more continuity of patient care as well as the efficiencies of size, many doctors do not want to be any bigger than they are.  This may be simply because there are too few incentives, too little personal satisfactions, and not enough spare time and extra money to create a need for change.  Let’s face it, most of us have to feel pain before we’re willing to change.

But, change is inevitable, and as the world around these physicians changes, they will need to change in order to survive.  Advances in imaging technologies, personalized medicine, hospital networks and reimbursements are requiring the very kinds of change that these paper-based physicians eschew.

When Change is Inevitable

EMR is part of the change, and one advantage that these change-avoiders may have is that today’s EMR systems far surpass the original iterations, with better workflows, faster learning curves and even the ability to integrate diagnostic images within the EMR.

It’s much easier to move from paper and film to digital when you don’t have to change everything about the way you work at once.  At the same time, it’s essential to realize that the processes you have in place may turn out not be the most efficient, especially when you begin to change to electronic records.   Interestingly, often neither staff nor are physicians able to provide answers when asked what impact they expect an EMR to have on workflow.  This may be because they simply do not have enough understanding of the positive impact that electronic workflows can have on an organization.  This is one reason why the ability to change and update workflows easily is a huge advantage in today’s EMRs.

Lingering Concerns

According to a recent NIH study, managers of practice offices that use paper-based systems perceived skills of staff and comfort level with IT as their biggest challenges to updating to EMR, along with resistance to change.   Some believed these challenges could be addressed with proper training.

Paper-based practices were also worried about decreased practitioner productivity during the implementation and its impact on day-to-day operations.

Paper-based practices have other areas of uncertainty as revealed in these commonly asked questions: “What will happen when the system is down during office hours? How will the visit details be recorded? Will the physicians have to convert back to note-taking, instead of entering information directly into the EHR?”

The final issues of concern when moving from paper and fil-based to digital-based systems focus on the unknown impact of the EMR upon patient health outcomes, including benefits derived from improved coordination as well as challenges such as potentially decreased privacy and security.   Interestingly, in the NIH study, paper-based practices, for all their hesitancy about adopting EMR thought that in the long term, moving from paper-based files to an EMR would improve patient care by improving communication among practitioners.  They also believed that EMR would improve patient privacy, with statements like this one: “This new EMR system will provide more security than the current paper-based system… every decision and step can be tracked by the sign-in process.”


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