Originally published December 2018
At a recent conference your colleagues were discussing their transition from an old electronic medical record (EMR) system to a new system. Despite the initial growing pains, they felt the original transition from paper records to an electronic system had improved their practice, and they were now eager to migrate again to a newer program.
Having read discouraging accounts online about some electronic record systems, you remain unsure about making such a change in your office practice. But feeling pressure to modernize and improve efficiency, you decide to take the plunge.
You select an EMR system recommended by one of your colleagues. The hurried delivery and implementation of the EMR surprise your clinic staff. It is not long before you experience regrets as you work after hours catching up on administrative work related to the new system. Your staff are also struggling with the new processes and morale drops. Overwhelmed and stressed, you contemplate scrapping the whole project.
Benefits and drawbacks
Electronic records can improve both the management of individual patient care and the overall effectiveness of the healthcare system. They allow physicians to access clinical information remotely, review historical data, share information with patients, and more easily collaborate with other healthcare providers.
But as with any change, technological change concerning management of patient records can be stressful, even for the most computer savvy physician. Indeed, implementation and management of electronic records is a recognized significant source of stress for physicians and is linked to burnout.1 Challenges for physicians and healthcare teams include the usability and interoperability of EMR systems, technical abilities of the physician and the team, lack of time for effective implementation, and fear that the technology will negatively affect doctor-patient interactions.2
The situation can be exacerbated by a difficult-to-use interface and inflexible functionality of an EMR system. For example, users may need to sort through an overload of on-screen information and may be challenged with confusing navigation. Data entry can be cumbersome when converting existing patient records into electronic files, and data integrity may be problematic when upgrading from an old EMR system to a new one. These and other factors have the potential to negatively affect workflow and ultimately patient care if not addressed. Physicians sometimes report working longer hours to complete data entry and related clerical tasks.
Among the main concerns for the optimization of EMRs stems from difficulties in the interoperability between systems, that is, how well the different technologies that comprise an EMR system interact and function. Compatibility issues may arise when, for example, there are multiple vendors offering products with different software formats.
Physicians may also be concerned about the effect that an EMR can have on the physician-patient interaction. If the transition means introducing computers for the first time in the examination room, less connection with patients and fewer discussions with colleagues may be an unintended consequence that needs to be taken into account.
Managing change, reducing stress
Many of the challenges and stressors associated with implementing a new EMR can be mitigated if physicians and their staff regard the transition as a project, devoting the time and resources—and doing thoughtful planning—to help ensure success. The transition may also be a good opportunity to assess, and where necessary, make improvements to existing work processes.
Selecting a system and vendor
There may be many EMR systems and vendors from which to choose, but not all will be suitable. Research and due diligence can minimize the risk of problems developing down the road.
When selecting an EMR system and vendor, consider issues such as how well the system fits the needs of your practice, the changes it will require to your existing office workflow, the transfer of existing files and data, the level of training and support the vendor can provide, security features, laboratory data management, and interoperability potential.
Once potential systems have been demonstrated and eligible vendors have been short-listed, it’s a good idea to begin using a new system on a trial or pilot basis, if possible. This may be an opportunity to request customizations to the system to fully meet the needs of the practice. Before entering into any long-term commitments, asking for references and following-up with the vendor’s past clients might reveal possible difficulties or provide reassurance.
Creating a transition team
A common strategy used in private offices and clinics when transitioning EMR systems is creating a transition team to oversee the implementation and liaise with the chosen vendor.
Implementation of an EMR system will impact each member of the healthcare team differently. It is important for the transition team to determine the needs of each of these individuals. Having the entire healthcare team buy in from the beginning is essential for successful implementation and transition, and generally reducing the stress level in the office.
Reviewing and assessing the ergonomics of the office and examination room will be important in minimizing any negative impact the new system may have on patient engagement.
One way to achieve this is by using an open configuration in which the computer does not obstruct eye contact between the physician and patient, and does not disrupt conversation. When the computer is used as an interactive educational tool during an appointment, patients are less likely to view the physician as being distracted by the computer.
Regular and extensive training is essential to successful EMR implementation, and training should be part of the chosen vendor’s service offering.
The learning curve can be steep, and there will likely be a reduction in productivity initially after implementation of a new system. Physicians should anticipate a temporary productivity loss by carefully choosing when and how to implement a new system, such as during a quieter time of year or by temporarily assigning additional office resources. This permits more time to be spent on adapting to the new electronic record system and helps reduce stress.
Support from medical associations
Many provincial and territorial medical associations offer resources and support services for physicians who are considering implementing an EMR system, either for the first time or upgrading to a newer system, or who are experiencing challenges with their existing electronic system. These resources include information about available funding options, vendor selection, advice on data management agreements, and help in resolving issues if difficulties arise with a vendor.
Practising in other settings
While physicians working in a hospital or a larger clinic might have no ownership and feel a lack of control over decisions relating to an EMR system, taking an active role in the planning and implementation of a new system might help ensure their needs and preferences are more effectively taken into account. It may also help alleviate the stress associated with the transition. Once the implementation is underway, working collaboratively with hospital administration and the IT department can go a long way in rolling out a system that functions as intended.
The bottom line
- Planning and change management increase the likelihood of a successful transition from paper to electronic records or between electronic systems, and reduce the stress of those affected.
- Providing clinicians and support staff with proper training in new workflow processes and the use of a new EMR system can help minimize the stress associated with implementing significant change in a medical practice.
- Collier R. Electronic health records contributing to physician burnout. CMAJ [Internet]. 2017 Nov 13 [cited 2018 May]; 189 (45) E1405-E1406. Available from: http://www.cmaj.ca/content/189/45/E1405. doi: 10.1503/cmaj.109-5522
- Ajami S, Bagheri-Tadi T. Barriers for adopting electronic health records (EHRs) by physicians. Acta Inform Med [Internet]. 2013 June [cited 2018 May]; 21(2): 129–134. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3766548/. doi: 10.5455/aim.2013.21.129-134