EHRs: We're not in high school anymore


There is a lot of griping about the adoption of EHRs--and with good reason. They're expensive, disrupt established workflow, require new training, contain design flaws and are error-prone. Even physicians who are eager to make them work are struggling. On top of that, almost half of the physicians who moved to an EHR system, in large part to take advantage of the money available in the Meaningful Use incentive program, are having trouble successfully attesting and obtaining the incentive.

One relatively young physician confided to me last week that he "hated" EHRs and vowed not to switch to one unless and until he absolutely had to.

But aren't all transitions challenging? It seems that some of the resistance by physicians to adopt EHRs is that it takes them out of their comfort zones and into new territory. Yet that's not always a bad thing. In fact, sometimes it's necessary and even welcome.

Take a look at another transition. My youngest is graduating high school this week, and believe me, it's bittersweet.  No more driving to soccer tournaments. No more cheer competitions. No more judging at debate meets. No more dinners with any of our kids around. Sigh.

But it's time for her to move on into uncharted territory. And that's uncharted for her parents, too. As the Washington Post reported this week, even good transitions present challenges and are a tremendous shift--but are also an opportunity to improve, to thrive.

And so it is with EHRs. They represent an uncomfortable transition into uncharted territory.

So why is graduation embraced, while EHRs are still the subject of much complaint?   

Part of the problem is that EHRs are still voluntary. Sure, a penalty will be imposed, but not until 2015. And even then for some physicians, the penalty isn't harsh enough to spur the change.

But graduation is an absolute. Once you've passed the requisite courses, it's up and out. 

It's also more familiar territory. After all, friends and family members have gone through the process and survived. The graduating kids know to some extent what's at the end of the tunnel, and they know it's fraught with trepidation but also something to look forward to.

With EHRs, the result is less clear, especially since EHRs are still not widely adopted, fully interoperable and being used to their full capabilities.

And graduation is seen as an accomplishment! The kids get parties and presents with their diplomas. Since when has a physician's practice received kudos for successfully implementing its EHR system? Sure, the incentive money is nice, but it's not exactly a pat on the back.

But much of the problem lies with the fact that change is a bumpy, sometimes painful process.

Which is perhaps why medical student Deepak Ramesh recently blogged that physicians should "get past" the complaints about EHRs, since they can improve care and make information more accessible. He notes that his EHR reminds him to ask patients important questions and helps him locate data more easily.

"EMR will continue to transform the way we practice medicine for the better, and the wisest approach to realize that it is just a tool that will reflect what we put in," he says in his post.

So perhaps those who have been reluctant can look at the change to EHRs a little more kindly.

And practices who successfully make the transition should throw themselves a party. - Marla

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