I’m here at the annual NextGen Users Group Meeting, in Orlando, FL. While I hope to get the skinny on making my group’s NextGen EMR sit up, beg, and perform like a lonely Australian Sheepdog, my main mission is more generalized: to learn how better to assist new MD’s in successfully adopting this, or any, EMR system.
And if South Orange County California is anything like the rest of America, that means focusing on small group practices of three or fewer physicians.
I’m attending as a member of an MSO, or Management Services Organization. You don’t call the big company in Pennsylvania for your specific problems, you call Jane or Fabian who helped you set up your wireless connections, advised you on hardware choices, and sweated alongside you when training your staff. Fix-it times from this dedicated cadre of local folks are measured in minutes, as opposed to hours or days — a key feature for practices of any size that I’ll explore in a future post.
I’m really looking forward to the “We Did It, We’re Awesome” sessions – the success stories of super smooth and efficient practices, or equally smooth and efficient implementations. There are a couple of orthopedic presentations that caught my eye: if there was ever a specialty practice that lived and died by seeing tons of folks and documenting detailed exams, orthopedics is it.
And of course, orthopods aren’t particularly known for being meek conformists. How NextGen – or rather, the orthopedists’ local MSO group – got them singing its praises should be mightily instructive.
Of course, the “Bend The System To My Mighty Will” sessions look fun, too.
Why Primary Care Practices Are More Challenging
The thing about orthopods, I just realized, is that they have a distinct training advantage over PCP’s, in terms of ease of adopting EMR’s: they’re used to learning new workflows and technologies on a regular basis. I suspect this is true of any surgical or procedural specialty, including Cardiology and Gastroenterology.
There’s always a new piece of hardware – literally – to put into patients, and a new certifying process from the manufacturer on how to fit it, drill it, cement it, and insert it.
PCP’s, on the other hand, have always had to make do with clever, soft fixes. There just aren’t any manufacturers forcing them to relearn how to operate on body parts for the 5th time since they graduated.
So instead of being accustomed to periodic hardware (tools and prosthetics) and software (techniques and procedures) “upgrades” from outside sources, PCP’s are more used to adapting from within, mostly from CME learning (changes in the standard of care, or state of medical knowledge).
They’re actually more used to doing things their own way, and less used to cheerfully adopting new ways of doing things, than the surgeons.
So What Does This Mean For Small Group Primary Care EMR Adoption?
If you’re an adviser or consultant on EMR adoption, realize that PCP groups will generally have less practice with change, and therefore be less comfortable and more demanding during the EMR transition process, than their procedurally-based counterparts.
The exception to this rule appears to be, not surprisingly, the more newly minted physicians and younger groups. They’re more likely to already have been exposed to EMR’s in their training, and still have the mindset of working – and compromising – in the way that residency training demands. Everybody, even the Chief Resident, still has to bow to and adapt to somebody higher on the totem pole.
If you’re a PCP like myself, especially if you’ve been in practice for a number of years and are used to the office working itself around you, start getting re-acquainted with the wonders of learning 
Most importantly, look around, and realize that the transition can successfully be made – IS being made by colleagues of yours every day. You had to learn new things and adapt to new processes earlier in your medical training, and you can still do so now.
Being more organized, cleaning up inefficiencies in your and your staff’s workflow, and willingly adapting to a cleaner, more secure, more profitable, and infinitely more detailed and powerful way of managing health information – these are things you can, and eventually must, do.
More later after the conference, and how medical informatics and technology can benefit YOU the practitioner, in addition to your patients.
