2 Secrets to Successful EMR Implementation

In my informal survey of Successful EMR Software implementations, I have found 2 very important factors that make EMR Software implementation and Adoption successful. I have used two words:

  • EMR Implementation
  • EMR Adoption

Let me distinguish between the two.

EMR Implementation is just about usage of the system. It implies that you are putting a layer on top of your practice workflow, trying to automate and speed up some of the tasks everyone does. It does not talk about improving practice and workflow efficiency. In other words, you are just doing things better. If your practice workflow is inefficient, with technology, you just make that inefficiency better.

EMR Adoption indicates that your practice uses and depends on the EMR system to help you become better and more efficient. It forces you to examine your processes and weed out inefficiencies.

What are the Two Secrets of Successful EMR Implementation?

  1. Continuous Training
  2. Focus on Adoption versus Implementation - Focus on Processes

Continuous Training

There must be a good plan for training with the right trainers. Sometimes training is done by IT people and that is ok, they know the application, and can show you what buttons to press, but they don't always understand the practice workflow. It is always better to be trained by clinicians that know the system or by consultants that are experts in practice workflow. It is not important to learn every trick in the book, every intricate aspect of the EMR software to prepare for every possible workflow scenario.

Good training enforces, over time, simulations of workflows, 'what-if' situations.

Another important aspect of training is Continuous training and reinforcement training - not to different in philosophies from CME.

Too many practices and provides underestimate the importance of training. In the process, they over estimate their (and their staff's) ability to learn the EMR system, however easy it may seem. Part of it is driven by the motivation to try to reduce costs.

Training is precisely the Wrong place to cut costs. It actually costs you more in the long run to cut training costs. I wrote an article in February 2013 about this.

EMR Software Adoption - Process 're-engineering'

After EMR software implementation, one mistake practices make is to assume that everything will stay the same day-to-day. You are investing in EMR technology to become better and more efficient. You should not just assume that by 'implementing' and 'installing' EMR Software, it is going to solve all your problems.

Again, distinguish between Implementation and Adoption. Strive to examine your workflows and how EMR software can help improve them - re-engineer them.


Once EMR Software is implemented and Adopted, it is a process of continuous improvement. It must be a sustained effort to stay on top with changes - staff turnover, software updates, regulatory updates (MU, ICD-10), etc. It takes continual effort to constantly strive for improvement to get results of increased efficiency.

All EMR Are The Same

"I've looked at so many systems, they're all the same - just tell me how much is yours..."
I hear this every day. So many of my colleagues at various EMR vendor companies echo this.
So, are they really the same? Yes and No. Let me break it down.
Yes they are the same, if... All you need is a 'vehicle' to go from here to there, then all cars are the same, without taking into consideration quality, manufacturer, long term value, resell value, comfort and so on. When it comes to EMR, they are all the same if -
  • the only reason you are getting an EMR is to get the incentive money from CMS
  • you believe your practice is so efficient, there is no scope or room for improvement
  • you think of EMR as just an 'island of automation' without consideration of other moving parts of your practice
  • you think of your Practice as a center for patient care, which is great; however you don't run it as a true 'business' trying to bring efficiency, increase productivity and therefore profitability.
  • you fail to recognize the benefit of ROI. Unfortunately, most practices run on a weekly/monthly cash basis rather than as an 'enterprise' that looks at return on investment
  • you fail to ask a critical question to your prospective vendor - 'tell me the background of this company/product'.
I will elaborate on the last bullet point - "Tell me the background of this company/product" a little bit later.
No, not all EMR software companies are the same.

  • Who is the founder of the company?
  • Does that person have an IT background.
  • If the founder is a physician what is the role of the physician - just an investor, or, an active designer of the system?
  • Does the company have a physician as a partner or owns 90% or majority off the company?
  • Where is the support based?
  • Who are the people that provide the support? Is it clinical people or information technology people? What are the credentials off the support people?
Now let me talk about why it is important to find out about the background of the company/product.
If you look at the history of EMR software, it is clear that originally medical record software was created just to record clinical charts. Billing software was the first piece of technology for healthcare. They did not talk to each other in the beginning. Then everyone realized that clinical charting software and billing software need to talk to each other to become efficient. However they were on different database platforms. They were then ultimately 'interfaced' - NOT - 'integrated on one platform'. May not matter to you, but there is a huge difference.

If a vendor started off as an EMR company and then added or merged a billing component to it, that shows that the emphasis is more on clinical documentation, and vice versa. It would be ideal to find a vendor who had the vision to create a system with a common database trying to optimize the business off a medical practice to begin with.

What would you call such a system? Practice Management System? I would call it Practice Business System. It sounds like a new term, but if you keep it in your mind it will allow you to focus on what you need and how to approach vendors when considering a 'system' for your Business; not just clinical charting.