Lessons Learned: How to overcome the cultural barriers to EMR implementation

Health care reform and government incentives have intensified the dialogue on electronic medical records (EMR). Despite the financial incentives for EMR adoption included in the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, physician response remains lukewarm. The HITECH incentives program fails to recognize that the greatest barrier to EMR adoption is not financial, but cultural.

Contrary to popular belief (even among ourselves), we physicians are not tech savvy. The practice of medicine is far more interpersonal than technical. Our decisions may depend as much upon a patient’s facial expression as on any objective data. That is how it should be. We got into medicine to work with people, not machines. Physician practices have never been centered around information technology (IT), so bringing a medical practice into that environment takes time.

A Transitional Approach

Ear, Nose and Throat of Georgia serves the metro Atlanta area with 20 physicians in 15 offices. We have offices staffed with anywhere from eight physicians to a single doctor. In 2003, we were ready to replace our outdated practice management (PM) computer system. In our strategic planning, we saw in EMRs an opportunity to strengthen our leadership position in the market and better serve our patients. We purchased EMR and PM products together to create a larger project.

Physician practices have never been centered around IT, so bringing a medical practice into that environment takes time.

The EMR adoption process was broken down into many incremental steps. After a short teaching session, physicians had a training version of the EMR, complete with fictitious doctors and patients, installed on their laptops. The physicians spent a few evenings working with the program to get used to its basic operations and functions. Once they were comfortable with these, we put the server communication software on their computers and showed them how to log in and use the same training EMR program on the server, which was configured with our custom templates. The physicians were then taught how to create chart notes using our templates so they could spend more time practicing, logging onto the server from home.

After a few evenings of practice, most physicians were comfortable with both the EMR itself and our custom templates. At that point, it was time to use the “real” EMR program on patients, but not all at once. Most physicians started with only one patient, usually one of the last patients of the day. Those first few notes took forever to complete, but with our approach, that was no problem. For a while, many of the physicians printed out the completed EMR note and put it in the paper chart. Why bother doing that? It was a cultural trust issue. With time, trust in the EMR increased, and the practice disappeared naturally.