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

by Michael J. Koriwchak, MD •

We advanced each physician at his or her own pace. For example, we started by having a physician complete an EMR for the last two patients of the day, then the last three, and so on. When ready, the physician would take on a half day of patients, then an entire day. There were no deadlines and no pressure. After getting settled with documentation, we had the physicians move on to workflows such as prescriptions, ordering tests and imaging. The last part included learning CPT/ ICD-9 charge code entry.

Our incremental approach served two goals. First, it allowed the cultural change to progress at an acceptable, sustainable rate. It also allowed the practice to implement EMRs without decreasing patient volume. It took almost a year to set up 20 physicians in 15 offices with basic EMR functions. There was no panic, no chaos and no loss of patient volume. We had our frustrating moments, but I am convinced that they would have been far worse with a conventional implementation plan that used “go-live” dates and other hard deadlines.

Strategies

We overcame the IT cultural barrier by creating an approach to EMR that differed from the prevailing wisdom at the time. Some of the strategies we used are as follows:

  • We recognized that implementing EMRs was not a project with a defined endpoint. It would instead be an ongoing “work in progress.”
  • We refused to be “led” through this project by our vendor. If we had a problem and didn’t like the vendor’s solution, we found another answer or created a solution ourselves.
  • We avoided “go-live” dates and hard deadlines for abandoning paper charts. Paper charts were eliminated gradually, via attrition, over two to three years.
  • We rejected the notion that we would have to decrease patient volume and lose revenue, even temporarily, to implement an EMR system.
  • Physicians were allowed to progress along their own timelines. We also offered—and continue to offer—each office and physician a fair amount of latitude on exactly how the EMR is used. For example, some physicians use speech recognition, some don’t.
  • Like any practice, we had some physicians who were enthusiastic about getting on an EMR system and some who were reluctant. We let the enthusiastic ones go first. This gave the reluctant ones time to watch the others.

Benefits

We began our EMR project with the faith that we could solve any problem we encountered—and there were problems. Some were predictable, while others completely blindsided us. Nearly six years later, however, it remains a successful work in progress.