There’s a pretty hot topic on the EMR boards right now, and that’s which EMR is right for small practices — or whether EMR is feasible for small practices at all.
The arguments go something like this: EMR’s are too expensive for the little guys, especially coming from the big vendors. The common ASP setup, where your patient data and software run on someone else’s servers, is putting an awful lot of faith in someone else’s business model. Or most frequently, EMR is just too cumbersome, my volumes are down, I’m losing money, I’m not getting enough help modding the system to my needs, I’ve had it, I’m outta here.
Well, I have my own thoughts on this thorny matter, from both the clinician and the EMR troubleshooter points of view.
We Can’t Afford To Lose The Little Guys
Especially if you are one of them.
Numbers vary, but up to 80% of MD offices are small group offices, i.e. 3 or less physicians under one roof, usually solo or 2-person offices, with a front office intake and back office medical assistant staff. If EMR isn’t for them, that’s an awful lot of the market for an EMR vendor to be writing off.
Plus, these are often the most highly motivated and devoted MD’s out there. They wouldn’t have gone into private practice if they didn’t feel confident in their clinical skills, their business acumen, and their commitment to practicing their personal brand of medicine.
“We’re ALL Individuals”
With a wry nod to Monty Python, however, being a rugged individualist isn’t all that it’s cracked up to be. As EMR vendors are finding out, it’s a very common affliction.
If you’re a solo provider, you’ve gotten used to making things go your way; that’s probably the main reason you went into solo practice to begin with. If you’ve developed unparalleled efficiency, unimpeachable workflow, and instantaneous process improvement, fine. You’re a better man than I, Gunga Din.
But chances are, without the feedback of other colleagues in your practice, your office workflow is very idiosyncratic. Jockeying to maintain your place among others in a medical office may not have been your idea of fun, but it would’ve prepared you for one thing: consistency to an agreed upon standard, for the sake of the staff and the good of the office overall.
Your way of doing things works for you…because it hasn’t had to work for anyone else.
Face it: it’s gonna be difficult, taking direction from an EMR vendor telling you to change the way you document, for chrissakes.
A Bitter Pill Either Way
It’s not easy convincing someone set in his ways to change. It’s like heart disease: if the first inkling of a problem is that elephant sitting on your chest, things are pretty far gone. If an EMR vendor’s first awareness of the problem is the “I’m ready to throw your system out the window” call, the problem has been brewing for a looong time.
Not surprisingly, rugged individualists display a certain…lag in calling for help. I’m talking about heart disease patients, now, of course.
What’s needed is nothing less than the complete restructuring of how an individualist does things. Not surprisingly, this works best with the individualist’s cooperation. Without it, all you end up with is a grudging acceptance, which will always be second-best in the physician’s mind compared to how he or she used to do things.
The goal isn’t to a workable fix that’s nearly as fast as the old way; it’s a new, superior-in-every-way end result, that makes the doctor’s office run smoother, safer, and more profitably all the way around. Something a doctor will want to voluntarily leave his horse behind for: one of those newfangled shiny steam locomotive contraptions.
If it’s any consolation, it’s eye-crossingly hard for the EMR staff, too. It’s no picnic, making their implementation work with each different office’s peculiarities.
So What’s The Solution?
There isn’t one, and that’s serious. Or rather, there isn’t any one fix that works for every small practice, because there are too many different practice styles out there.
I do have some thoughts on general approaches to having the East and West meet happily in the middle, but I very much want to hear your thoughts first. Fill out a Comment below, or click this link to email me, but tell me: What do you think is the problem, and the solution, to EMR’s for solo and small groups?
