EMR – Implementation and Adoption Barriers

The Government officials are mandated to ensure that every healthcare institution should have Electronic Medical Record (EMR) systems in place. Despite many benefits of the modern-day tool, many clinical users & healthcare providers are apprehensive to implement EMR. 

Whilst EMRs possess many useful features to help streamline the healthcare processes, some people find the entire system overly complex and feel that they could take smashing care of patients even without it.

But when it is implemented properly, EMR serves as a stonking tool to preserve critical clinical information and increase workflow efficiency, TAT, continuous improvement of patient & provider experiences. Having said this, there are a few issues that you need to overcome if you want to get the full benefits of EMR.

In-correct Goals 

IMPLEMENTATION PERSPECTIVE

What do you want to achieve out of your EMR implementation? Have you set realistic goals and expectations? Is the goal to just digitise your paper records or is it to improve patient care while bringing in 20-25% increase in revenue? Only when you have a clearly defined and understood set of goals and expectations, then you will be able to evaluate the success or failure of EMR implementation. The goals provide you the criteria to evaluate the implementation and define a plan to overcome any deficit during the EMR implementation. Taking everything into account, the product owner should perform a detail due diligence whether the healthcare provider (Hospital) is ready or not for the EMR deployment and adoption.

PRODUCT PERSPECTIVE

Most EMR deployment fail due to product design and its capabilities. Therefore, it is very essential for the organisation to choose the right product which could have been designed and developed to enabling the following capabilities:

• Sub second response (faster than paper)
• Ease of use (zero typing to perform the clinical documentation)
• Required zero training to the end users
• Gadgets independent
• More of open source tool usage

Inadequate Infrastructure

Lack of concrete IT infrastructure is one of the most common causes of failure in EMR implementation. Most of the healthcare organisations lack the technical skills and infrastructure to support EMR safety and fail to take care of aspects such as networking over good bandwidth, good wireless coverage, regular data backups, patient data security, interpretability or scalable data centers. All such issues can severely reduce the productivity of clinicians and hamper the patient care. Without having the state-of-the-art infrastructure in place, the availability of patient longitudinal records at point of care would always be questioned to enable quality of care within the individual reach.

Limitation of Technology Usage

In today’s world with the rapid increase in the number of mobile devices, everybody is used to work in a certain way – mobile-based devices have become the natural way of working, touch has replaced type in most of the mobile devices, compatibility across devices has been taken for granted, computers are supposed to work really fast.

The EMR systems need to adapt themselves to such changing technological advancements. Incorrect technology, which is nonscalable, non-responsive, does not work as fast as people are used to, or which cannot capture multiple data points, can soon be discarded by the users. Maximum failure comes in the way if the product has got the performance, navigation, nonstandard controls usage & mobile gadget dependency across the EMR application.

No Stakeholder Buy-in

Although, EMR implementation involves a lot of technology activity, it certainly cannot be only an IT decision. There are multiple stakeholders who are involved in the use of EMR and the buy-in from all the users is essential. Successful EMR implementation requires physician champions who are early adopters and can help in getting various stakeholders on the same page, respond to queries in a timely manner and help clinicians in reaching a common consent.

It is important to note that the EMR implementation involves multiple factors such as leadership, change management, training and technology; therefore, it must support both technical and personnel-related components. The complete solution stack of EMR involves only 30% of technology and 70% is catered by people & process. Ideally it should be people and process driven instead of technology driven.

Non-availability of interdepartmental processes to implement changes

The objective of the EMR deployment is 100% adoption from day one onward and it is mostly people and process driven. Therefore the entire organisation must emphasise to execute the workflows in line with process which could be supporting to get the expected outcome from EMR at PoC.

In certain cases, there could be a fundamental change in the way departments work and in such cases, hospitals need to spend time in designing and implementing processes pre and post deployment of EMR.

Adhering to processes should be mandated by the management to the HODs and user level for better adoption to get the utmost use of the clinical outcome to the HCPs toward enabling the quality care, patient safety and patient experiences.

Budget constraint

There is no denial that the cost of EMR & its deployment is huge. This involves Infrastructure, software, implementation assistance, training, support and ongoing subscription & support fees of the application. In fact, the cost of EMR is the number one reason why most healthcare institutions have not yet made the switch from paper to paperless & digitised.

But the benefits of EMR are innumerable and more significant than the cost of implementation. If you find EMR costs to be out of your budget, you should make a thorough assessment of your needs and consult with vendors to develop economical EMR solutions. However, the recent trend from the vendor to provide the quote & bid based on op-ex model which helps to make it more cost-effective and affordable.

Clinical template designing limitation

Some hospitals may find that, even after careful planning and implementation, EMR just doesn’t provide the functionality they need. The clinical templating/designing is one of the major features of the EMR for clinical documentation for clinical users which decide the success and failure of the EMR implementation programme and the project.

As the usage of EMR increases, a scenario comes to the fore where the user is not able to enhance the template designed by adding few more components on their own as it might be that new clinical guidelines could have published to treat a certain disease and disease type. As a result, the clinical user becomes hesitant to use it as they will not be getting related clinical reports for further study and analysis.

Therefore, the application should be capable enough to change the clinical content based on the user needs as and when it is required, instead of making the users dependent on the product owner to make L1, L2 level of changes in the existing content.

Clinical users resist using EMR

Clinicians refuse to accept new system either because they do not believe in its capabilities, they are very much convinced that their way of doing things can produce better results, or perhaps because they are intimidated by it. Once again, you need to identify a super-user who can encourage others to adopt EMR and feel more comfortable about it. A peer-to-peer approach will work best in this situation. On the other hand, the hospitals should come-up with basic minimum reward in the form of incentives which has proved to be beneficial in the past.

Missing management mandate

This is one of the major missing elements. The organisation does not appraise the high-level goals and deliverables with the HODs before bringing this change. Every organisation should perform internal change management before implementing the EMR whereby the management should pass the message as to why this initiative has been taken with all the goals and deliverables. To get 100% success, the process would be put in place which will be adhered by each stakeholder right from the departmental HODs to the end users from day one when EMR goes live.

Continuous change management & training

Post EMR implementation, change management and training should be a continuous activity at the organisation level else the adoption rate will fall drastically and bringing it back on track will become a nightmare.

Therefore, the concept of train-the-trainer would be more effective to mitigate this issue, better it could have been suggested to align this training for all the new hirees during their orientation programme right after on boarding of new hirees.

This training would be more on the value added outcome by comparing before and after the EMR deployment which can be co-related with RoI, efficiency, TAT, control on possible clinical errors and patient provider experiences.

Overcoming barriers / Issues in implementing EMR

• Continuous customer buy-in
• Clear mandate in line with EMR deployment goals – organisation level
• Mobility based EMR
• Must be a clinically driven – Project management and escalation
• Don’t reinvent the wheel
• Strong clinical documentation tool with zero technical dependency
• Clinical information interoperability
• Continuous clinical content improvement, training and change management
• Slicing the redundant data capturing
• Providing clinical predictive analytics – organisation level
• Adopting newer technology time to time

Abdullah Saleem
Group CIO, OMNI Hospitals