A study published in April of 2009 indicated that 73% of physician who purchased an EHR in the last 3 years either replaced the EHR product they purchased or where not able to use the product for meaningful documentation of 80% of their patient visits within the first 12 months of implementation.

Why does it take over a year to be successful and what can we learn from the 27% that are able to effectively use their EHR within the first 12 months?

Is the failure the software?

Is the failure the training and support?

Is the failure the lack of true clinical and operational transformation that is require to achieve success?

Mark,

Do you have a reference for that article?

My feeling : It's the training and support. When most people look to "Go electronic", they reach for their most common real-life experiences to guide them, cognitively, about "What is this going to take?" : For most people, that's installing some software on their computer.

The problem is, this experience is a poor model to understand EHR implementation :
1. It implies "This is something you can do with an instruction book and maybe a little help".
2. It implies "This is something that is experienced at the computer, and the computer only."
3. It implies "It generally takes a week or two to 'get really good' at it."

What it misses is :
1. EHR implementation means a THOROUGH examination of all of your clinical workflows, and then slicing-and-dicing them, and reorganizing them under a new electronic paradigm.
2. "Support" is NOT an instruction book, and NOT a 2-hour class, but a continuous, ongoing monitoring of physician, nurse, and pharmacist behaviors - And to achieve this requires an entire support mechanism of its own.
3. The 'learning curve' is often longer than anticipated.
4. The 'budget' is often higher than anticipated.

Most people have "the morning after syndrome", and then blame the software, blame the doctors, or blame medicine in general for being too complicated -

I think if you present a better cognitive model to the head decision-makers, ahead of time, they'll make smarter budgeting and planning decisions, and have higher success rates.

- Dirk

The high failure rate is due to the lack of support and ongoing maintenance and training by the vendor. Choosing the right software, vendor and training is critical. Microwize Technology can make the difference.

Microwize Technology has been helping thousands of health care professionals since 1997 with billing, scheduling, and electronic health record programs that allow the provider and staff to focus on patient care. These solutions, coupled with our computer services, have proven to increase revenues, reduce costs, and enhance employee productivity. With Microwize’s seasoned team of professionals our implementation success rate exceeds three times the national standard.

http://www.microwize.com

Medisoft, Practice Partner, Medinotes, Peak Practice, EMR, IT Support.

Let me take a different perspective. The high failure rate has absolutely nothing to do with user training programs, vendor support or ongoing maintenance. Increased need for training, lack of adoption and the like are symptoms of an application (re: EMR) that was designed around features rather than the user, their needs and environment. Treating symptoms doesn't address the cause of the problem: the lack of a formal design process during the design and development of the software.

Kevin
Electronic Ink
http://electronicink.com/

I think one of the greatest reasons why most EMR systems fail is because over 80% of the systems out there are multi-specialty systems. Practices that successfully implement EMR systems are typically practices that choose systems designed for their specific specialty. While training and support definitely play an important role, choosing the right system that fits your practice's work-flow is most critical.

My take is the clinical content in the EMR (order sets, clinical documentation templates, etc.) doesn't support the practice and/or environment well. Non-productive with process, inapplicable in the environment, change with new evidence and practice standards, or just wrong and unsafe, etc.

Big EMR implementations in acute centres, like say involving 100's or 1000's of order sets, can fail for many reasons. Training is definitely one of them. I'm sure anyone who has done it can list a dozen of major challenges off the top of their head in less than a minute. Good process (governance and build) is key. To say the least, the more you do the harder it gets. Unfortunately thats when you have the potential to start seeing real improvements in patient care quality and outcomes, improvements in operational efficiency, and financial ROIs.