Electronic Medical Records (EMR) - Overcoming Barriers to Adoption

Overcoming the Barriers 
to a Smooth EHR Transition  
Jane Adler, MD
NeoVista Health

What This Presentation Will Deliver
I. 2 common myths about EHR adoption
II. Why so many EHRs fail to deliver on their
promise – and run over time, over budget &
cause problems in the practice
III. The 3 things that you must have for
successful EHR adoption

When these 3 elements are in place:
A faster transition
A smoother transition
A greater return on your investment
What This Presentation Will Deliver
• better clinical outcomes
• a stronger bottom line
• greater likelihood of achieving
meaningful use

What I Cannot Deliver
Everything you need to know or every
tool or strategy you will need to reduce
problems and increase the speed and
success of your EHR transition...
in a 45 minute presentation

Proven Strategies
How can you apply these proven strategies to
your practice or your healthcare facility
to get the results you want?
• Every practice is different
• Every EHR implementation is unique

Myth #1
“Successful EHR adoption is all
about selecting the right system.”

Guaranteed “Sure Thing”
Research reveals
that when it comes to
electronic records systems,
there’s no “sure thing.”

• One or 2 systems would be clearly
superior – “safe bets”
• Similar practices implementing the same
system would get very similar results
Myth #1
“Successful EHR adoption is all about
selecting the right system.”
If that were true:

Just One Example
Two similar practices – same system, same
implementation team.
Practice #1
• Primary Care
• 3 Physicians
• 7 Staff
• Suburban Location
• Families & Retirees
Practice #2
• Primary Care
• 4 Physicians
• 11 Staff
• Suburban Location
• Families & Retirees

9 Months Later
It’s clearly evident that successful EHR adoption
is not just about selecting the ‘right system.’
Practice #1
• Functioning system
• Productivity is up
• No more temporary
help needed
• Already seeing
bottom-line benefits
Practice #2
• Productivity down
• Increased patient
waiting times
• Patients leaving
practice
• Non-functioning EHR

Myth #1
Selecting the right system is important –
but it’s not the only factor influencing
success.  
What matters most in a system:  
• Reliable vendor
• Options & features that you want & need
• Certified (or will be) for HHS requirements

Myth #1
• Myth: The key to success is system
selection
• Reality: Selecting an appropriate system
is only 1 factor in EHR success

Myth #2
“Purchasing a certified system
practically guarantees that you will
achieve meaningful use and get those
government incentive payments.”

Myth #2
In July of this year two “meaningful use”
regulations were released:
• What the technology must be capable of
doing to be certified
• What you must do with that technology to
qualify for payments

Myth #2
Many physicians rush to purchase
“certified technology” without planning
an effective transition strategy.
Without an effective transition strategy
you will never realize the promise of
the technology.

Myth #2
• Myth: Purchasing a certified system
practically guarantees achieving meaningful
use and getting money.
• Reality: Getting money depends on whether
your practice is able to use the certified
technology to its full potential.

II. Causes of EHR Failure
Why do so many EHRs fail to deliver
on their promise?
Why do so many EHR projects run
over time, over budget & cause
problems in the practice?

35-50% Failure Rate
The implementation failure rate for
EHR projects runs between 35% -
50%
(some estimate up to 73%).
IEEE Spectrum
August 25, 2009

How Do You Define Failure?
• Prolonged implementation?
• Over budget?
• Lack of full adoption?
• Clinical errors?
• Lack of proficiency?
• Abandonment or deinstallation?

• Up to 30% of practices
stop using their systems
or even remove them
within one year of
installation.
American Medical News
August 24, 2009
How Do You Define Failure?

How We Define Failure
EHR failure occurs whenever a
system fails to deliver on its
potential to:
• enhance patient care
• increase patient productivity
• increase practice efficiency
• make life easier and better
• deliver a clear return on
investment

It Doesn’t Really Matter
If it’s your practice that fails to get
good results…
the failure rate might as well be
100%

What Causes Failure?
What causes failure?
What can you do about it?

Is it the Technology?
• Inflexible?
• Can't meet the needs of the
practitioner?
• Makes the work more difficult?
• Reduces the time physicians can
spend with patients?
• Makes physicians servants of
the technology rather than the
other way around?

Is it Vendors?
• “They're only in it to make a sale?”
• “They lack commitment to delivering
quality products that really benefit
physicians and patients?”
• “They offer only marginal service &
support?”

Is it Us – the Physicians?
• Do we refuse to take advantage
of something that will lower
healthcare costs and improve
patient care?
• Are we unwilling to learn new
skills?
• Do we resist all change?

Over 2 decades & millions of
dollars of research in medical
informatics reveal…
What Really Causes Failure?
the most frequent cause of EHR
problems, disappointments &
failures is something else.

Inadequate management practices account
for 65% of the factors associated with
project failure.
Health IT Success and Failure:
Recommendations from Literature and an AMIA Workshop
B. Kaplan & K. Harris-Salamone
Journal of the Am. Med. Informatics Assoc., 2009
Research Indicates Something Else

Research Indicates Something Else
In practices with EHRs implemented, the
researchers found that major impediments
were ‘people barriers' – lack of support for
the system from physicians, non-physician
providers, and other clinical staff.
Lorenzi, et. al.
How to successfully implement EHRs
in small ambulatory practice settings
BMC Medical Informatics 2009

“Some flops can be blamed on a software or
hardware lemon. But most of the time the
culprits are all-too human problems, poor
planning, poor communication, and poor
training.
EHR implementation, it turns out, largely
depends on how you handle people, not
computers.”
Medical Economics, July 2008

Most failures are not the victims of flawed
technology, but rather organizational and
people related issues.
N. Lorenzi, et. al., MEDINFO 2004

Our Purpose
• So YOU can avoid the barriers that have
plagued so many transitions in the past.
• So YOU can more rapidly and cost-effectively
transition to electronic records
To put the results of this research into a
format that can benefit physicians and
clinical practice owners.

Research reveals that there are 3 critical
elements that need to be present for successful
EHR adoption.
3 Critical Elements

3 Critical Elements
The
Right
System

3 Critical Elements
The
Right
System
The Right
Change
Management

3 Critical Elements
The Right
Training
& Support
The
Right
System
The Right
Change
Management

3 Key Elements
Vendors – can take care of technology
But vendors can’t:
• Build staff enthusiasm & motivation
• Manage the Project: Decide who will
do what when
• Design the ideal workflow for your
practice

Managing Change is an Inside Job
• It’s very difficult for any outsider to
get genuine buy-in and support for
change from practice staff within a
matter of weeks or even months
• It’s up to practice leaders to lead the
change

The 7-Step System
Allows you to transfer much of the
change leadership and virtually all of the
internal project management to your
practice manager or other staff member,
so you can maintain patient productivity.

The 7-Step System
• People Management
• Project Management
• A Strategy for Training

The 7-Step System
Build the Case for Change
Identify the Guiding Team
Motivate with an Inspiring Vision
Promote Staff Collaboration
Get Everyone Moving
Build Confidence
Maintain
Momentum

Build The Case For Change  
© 2010 NeoVista Health Strategies
Step 1 – The Case for Change
• Get everyone in your practice
motivated to do things differently.
• Give them a strong “reason why”
change is necessary.

“Without motivation, people won't help
and the effort goes nowhere.”
John Kotter
Leading Change

If staff members don’t feel that change is urgently
needed, if they don’t fully appreciate the benefits of
that change, no amount of cajoling, financial
incentives or even penalties will create the kind of
commitment, collaboration, and active participation
that you need to get the maximum benefits from
your EHR system.

• The critical make-or-break factor in
successful electronic records adoption.
• Unfortunately most practices leave this
to chance.

Meet Susan: 
 
A valuable employee 
 
A real “team player”  
 

What does Susan think? 
 
Does Susan feel an urgent need for
change?  
 
Susan believes we’re getting an EHR
because… 
 
?

How enthusiastic will she be? 
 
Will she make time for and apply herself to
training?  
 
Will she encourage others in the practice?  

Building Urgency
The essential first step to successful
EHR adoption.

How to Build Urgency
• Physicians & providers
• Other clinical staff
• Non-clinical staff
Different factors influence:

AverageReimbursementforALLE&MCodes
Reimbursement
2004 ‘05
$60
Source: 2004-2007 Physician
Practice Fee Schedule Surveys
‘06 ‘07 ‘08
$70
$80
$90
$100
%IncreaseinPracticeCosts
2001 ‘03
12%
9%
6%
3%
15%
18%
Costs of Operating
A Practice
Source: AMA, Division of Economic
Health Policy Research
‘05 ‘07 ‘09
Increasing Costs Decreasing Revenue/Visit

Step 2 – Guiding Team

Physicians, particularly practice owners, tend to take
on too much management of the project details.
This negatively impacts productivity.
With the right project manager & the right system to
follow, you can maintain oversight – without taking on
too many of the details.

“A feeling of urgency helps greatly in putting
together the right group to guide change and in
creating essential teamwork within the group.
When there is urgency, more people want to help
provide leadership…”
John Kotter
The Heart of Change
Effective project leadership requires a
sense of URGENCY.

A project manager without urgency = project failure

Motivate with an Inspiring Vision of the
Future
Step 3 – Motivate

Step 3 – Motivate
How will each staff member
benefit from the system?

Step 3 – Motivate
Vision
Checklist

Promote Staff Collaboration  
 
Builds “psychological ownership” of the project
Step 4 – Promote Collaboration

Involve staff members in planning
& in developing new policies &
procedures for the practice.

People who plan the battle 
rarely battle the plan.  
 
 

Involve staff members wherever
you are in the transition process:
• Planning
• Implementing
• Enhancing benefits
• Solving problems

Workshop Staff Meetings
• A structured format
• Gets input from all participants
• Focus everyone’s attention on just one topic
• Goal directed
• Time limited
• Builds ownership of the change process & the
system

Workshop 
Chart  
 

Workshops make everyone an important part of the process.
 

Workshop Staff Meetings
Depending on the size and structure of your
practice hold separate Workshops for:
• Physicians
• Other clinical staff
• Non-clinical staff
• Different departments

You Need an Accurate Workflow Map to:  
• Get the best possible system configuration
• Facilitate workflow redesign
• Enhance vendor communication
• Improve planning process
• More easily diagnose & correct problems

Unfortunately Many Practices Neglect This Step: 
• Takes too much time
• Too complicated
• Too costly to hire a consultant

Benefits of Involving Staff in Mapping:  
 
• They are already doing the work to map
• Greater accuracy
• Builds psychological ownership
• Gets staff invested in preventing problems
• Gives staff a tool for increasing efficiency
• Keeps costs down

Screen capture – process mapping  
 

Process maps are important:  
 
• Planning your transition
• In process of implementation
• To get best possible results from your
system

Get Everyone Moving in the Same Direction
Step 5 – Get Everyone Moving

Project Management
• Effective planning
• Keeping the project on track
• Reducing costs
• Enables physicians to maintain oversight,
without negatively impacting productivity

 
Gantt Chart

Gantt Chart
• Sequential and parallel activities
• Dependent & independent activities
• Enables greater flexibility
• Enables time and cost savings
Problems may develop, changes may be
needed.
Distinguish between:

Training
• Effective training builds on motivation
• Ensure effective & well-timed training  

Resources & Contact Information
• NeoVistaHealth.com
• NeoVistaHealth.com/FOMA

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