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?
5 comments ↓
Interesting article. I’ve often found that it’s easier to implement the smaller groups, because there are less political barriers. I also think that a number of EMR vendors are creating pricing models that match smaller physician offices like a pay per provider per month or pay per visit as opposed to the lump sum method that most people use and can’t be shared with many people in a small office.
Small groups seem to have it tougher: there’s less “death by committee,” but less “depth in the backfield,” too. An MD or two, plus an MA and front office person, means everyone multitasks, and any one person not playing along can put the kibosh on the whole implementation.
Some of the most oft-described tactics to improve physician efficiency using EMR, involve shunting tasks to staff. That’s a problematic recommendation, if the staff is running at full speed already, and there aren’t 4 other MA’s and 5 other front desk staff to share the shunting.
Luckily, comprehensive EMR’s (involving scheduling, billing, and intra-office messaging - EPM’s) also work their magic by improving the office’s efficiency overall. This is where staff can get the breathing room they need.
Prices coming down for smaller offices is definitely an idea whose time has come, given the large number of small group practices out there. That market is too big - and too important - to ignore, like Target or Walmart ignoring families with just 1 or 2 children.
My husband has been in solo practice for 25 yeaers and we are at the beginning of the process of switching to EMR. I used to be a dealer for Medisoft so I embrace change but my husband is very anxious about not being able to use the program efficiently. I feel that he/we need to interact with other offices that have successfully made the transition so we can have a role model. Our trainer doesn’t want us to do that and won’t assist us in contacting other offices. I have always learned a great deal from working with other offices and sharing their struggles and triumphs. I want to find a user group forum if one exists that is for office staff and physicians, not the trainers. Any ideas?
Thank you for sharing!
There IS an online resource that I troll regularly, http://www.emrupdate.com/ — but it’s a bit like the wild, wild west. Flaming threads are not uncommon, and you are getting the undistilled comments of fellow EMR users, frustrations and all.
That said, I believe it’s always valuable to study “raw data.” But I’ve seen more than one post that focused on just one aspect of an issue, so I’d recommend being patient and balanced following the threads.
My own experience parallels yours, with a caveat: it’s valuable to see how others have successfully integrated your system into their offices, but your own office may not quite be ready for that, yet.
If you’re at the “We’re not quite decided on this particular vendor” stage, you should absolutely be talking to other folks using it live. But if you’ve taken the plunge to go with it, there may be other things your office needs to focus on first, like repetitious simulations of sample cases, scanning and abstracting protocols, etc.
Sometimes, looking over at what “advanced” users are doing is analogous to a white belt in a karate class looking at what the 2nd degree black belts are doing, and wondering why the instructor is “holding back” by not teaching those fancy jumping reverse spin kicks.
Of course, if you really do want to contact other users of your particular system, you could just go over the head of your trainer, and contact the corporate head office
Leave a Comment