According to a 2008 survey conducted by the CDC, only 38.4% of physicians reported they were using full or partial EMR systems, and 20.4% said they were using minimally functioning EMRs for e-prescribing, ordering, and viewing results of lab tests. Only 17% of physicians reported using basic EMR systems. Clinicians are reluctant to use a system that does not mirror their practice style. Since programmers, who are not clinicians, develop most EMRs, the applications are not widely accepted.
What about hospital-based EMRs? A survey recently reported in the New England Journal of Medicine (2009;360[16]:1628-1638) showed that only 1.5% of hospitals in the United States have a comprehensive electronic-records system. An additional 7.6% have a basic system. According to the study, larger hospitals and teaching hospitals were more likely to have electronic-records systems. Hospitals responding to this survey cited “capital requirements and high maintenance costs as the primary barriers to implementation.”
Based on what I hear from clinicians, the main reasons they are not readily adopting the EMR include: (1) it is too cumbersome and fosters depersonalization, (2) too much typing is required, (3) too many clicks are required for even minor tasks, (4) it is user-unfriendly, (5) it is too rigid—all notes look the same, (6) it is too time-consuming, and (7) it is too costly. One would think that EMRs should be built to conform to the individual practice style.
Although dictation remains one of the most efficient uses of a clinician’s time, a clinician may be drawn to utilize an EMR if there are offset benefits such as automated scheduling, ordering, billing, and prescription writing and integrated information systems. It appears that initial costs of an EMR system start around $71,000, with an annual cost of around $2,000. Unfortunately, we cannot simply go into an office supply mart and compare the features of various EMR products and choose the one that meets our need and is within our price range. There doesn’t seem to be uniform price structure to allow that kind of shopping.
Should we demand progress on implementation of user-friendly, cost-effective EMRs so that we can have access to a safer, more effective health care system, or is it all just “smoke and mirrors” and too much trouble? I welcome your comments about EMRs. Please send your responses to PAeditor@qhc.com.