Should doctors be “forced” to use EMRs?

Tom Closson, the Ontario Hospital Association (OHA) President and CEO, created a bit of stir at the eHealth 2011 conference in Toronto when he suggested that doctors should face real consequences for not adopting electronic medical record systems such as not getting paid.   This same sentiment was expressed in a recent article in the Canadian Medical Association Journal.

Tim Wilson, a fellow Canadian eHealth blogger, explored Tom’s comments in a recent blog post.  I commented on this blog post with the following observation:

I agree that mandating EMR use is not the answer, at least not until we get more physicians using EMRs. While it might sound like the easiest path to take, forcing physicians to use an EMR casts them as technology resistors who simply aren’t smart enough to realize the benefits that EMR’s have to offer. Given their education and their use of some quite advanced technologies in other aspects of the practice of medicine, one has to wonder they aren’t pounding down the vendors’ doors to buy an EMR.

I suggested that it was perhaps a bit hypocritical of those who still use pen and paper for many daily work activities to admonish physicians for doing the same.

If we are unprepared to ditch pen and paper, what right do we have to ask physicians to do the same? Clearly there are usability issues still remaining with many EMR products and forcing physicians to use products that don’t fit how they work is not the answer. While I am not naive enough to suggest that usability is the only issue standing in the way of massive EMR adoption, I do believe it is a contributing factor.

What are your thoughts on this matter?  Head over to Tim’s blog and join the debate.

Mike

2 responses to “Should doctors be “forced” to use EMRs?

  1. Mike @416-991-7733

    As a part-time manager of a new family practice (a spoke site according to the EMR vendor) I have been thrown into the deep end of EMR integration. The physician (currently the 5th in a FHO but the 1st at this particular site) is new, young and has no problem seeing the benefits and embracing technology. We had the FHO’s EMR installed for day one of the practice (to the first year hefty total cost of $15k I might add).

    The current challenge we are experiencing is actually the funding partners (OntarioMD for the FHO), the ministry (OMHLTC for the FHT -RNs, NPs, and allied health professionals) and the vendor. The funding for our ver. 4.5 install has been with-held due to a version problem. I was told, after the install was complete, that OMD was no longer funding ver. 4.5 of the software…even if joining an existing health team and having no other choice on version numbers! “We are ONLY funding 5.1” says OMD. OK, now over to the other funding partner who support the FHT, the ministry. They are NOT funding 5.1. Both funding parties are aware that the two groups (FHO and FHT) must move in unison for a software change/upgrade/install BUT the funding groups cannot agree on a version number to support. So I sit dumbfounded by their lack of transparency and ability to see the conundrum they themselves have created.

    As for the vendors themselves, I can only speak of the experience we have endured with ours…apparently a market leader in terms of market share. They have had issues with staying on top of upgrading their clients to the latest versions of their software. Even when doing upgrades they have apparently had issues with their data migration from one version to another. Now, after much conversation with various Vice Presidents at the software company, I have been assured that these problems are either under control or a thing of the past. This may be true, and I believe it is, but it seems the funding partners and the healthcare community need an update.

    Do I believe there is a challenge in EMR adoption with new physicians? Not at all. In my opinion the current issues are with the funding infrastructure and vendor misinformation feeding a fear of change.

  2. I think there are a lot of issues with EMR which nobody wants to talk about, but you can be sure that physicians are talking about them amongst themselves.

    First is the lack of system interoperability. What’s the point of having a fax machine if nobody else has one? What’s the point of having an EMR if the hospital, labs, xray departments, specialists and all others who I communicate with don’t send me documents electronically. By now we should all know, ‘its the network, stupid’. EMRs are not even applications, they are an enterprise resource package. Most EMR vendors don’t know that. They are trying to emulate Word, when they should be emulating SAP.

    Second is the lack of commitment from government to have a sustainable funding program for as long as EMRs are expensive. Maybe the cloud will decrease EMR costs, but ASP models didn’t. ASPs are almost as expensive as client servers. If government is wishy-washy about their commitment to EMRs, doctors will also be wishy-washy. Government is the dog that wags the healthcare IT tail. If they lack enthusiasm, they shouldn’t expect different from physicians.

    Third is the poor segmentation of the market place that government policy and programs envision. A one-size fits all program will not lead to wide-spread adoption. About a third of primary care physicians practice on a part-time basis. They have other things they are doing in addition to office practice. Working at the local nursing home, emergency department, hospital, derm clinic, vein clinic, etc. The one-size fits all programs don’t work for those part-timers. As long as government programs assume that all primary care physicians are the same and practice in the same way, they will face difficulty in getting the last set of physicians to participate.

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