At Last, a Guidebook for Choosing Electronic Health Records

Based on research of more than a dozen technology vendors and 50 physician practices, a new book offers clarity and case studies for doctors who want to use electronic health records.

Although electronic health records promise to reduce medical errors and boost personalized care, their cost, inconvenience and uncertain benefits are keeping physicians away. Even physicians convinced that they should invest in the technology delay for fear of spending huge sums on the wrong technology. An overwhelming surfeit of options just boosts their confusion.

Based on research of more than a dozen technology vendors and 50 physician practices, a new book, "EHR Implementation: A Step by Step Guide for the Medical Practice," offers clarity and case studies. All physicians interviewed had tried and rejected at least one EHR system and had a sense of what worked and didnt, said Carolyn Hartley, co-author of the book and CEO of Physicians EHR LLC, a consulting firm advising physicians on technology.

An EHR system usually requires big changes in the most basic routines, so the secret to getting an EHR system implemented is less technology management than people management, Hartley said in an interview with "In a physicians office, work flow is driven by paper triggers, but with an EHR, there is no paper."

She described an analogy used by one physician, "Buying an EHR is not like buying a car; its like buying a car for your teenager. A salesperson can tell you everything you need to know about the car, but cant teach your teenager how to drive."

By far, the biggest barrier to EHR adoption is a good implementation strategy, Hartley said. And thats something vendors are neglecting as they rush to capture the small physician markets. Physicians need to find vendors willing to go slow and work with individuals, not those who just want to send them a disk.

/zimages/4/28571.gifDoctors seek guidance on EHRs. Read more here.

Hartley recommends that physician practices start slowly, implementing one module of the EHR system at a time. "Figure out the workflow for simple processes like renewing a prescription or recommending a patient to a specialist. Go to your workflow pain first and see what the software tool can address," she said. Once a practice has made adjustments to one module, the rest of the software will come in time.

The most common mistake physicians make is not knowing what they were getting before purchase. "Physicians underestimate the change that is going to happen inside the office," said Hartley, "and generally speaking, the vendors dont tell them either." Other common mistakes are not knowing the budget for the technology and not asking for help. Hartley said the latter is "mainly because of their medical training that tells them, `Youre the doc, you make the decision."

She summarized her top advice for physicians adopting EHR:

1: Ask you colleagues what theyre using.

2: Do your homework ahead of time. Sit through online demonstrations, but dont sit through five in-person demonstrations, which can take more than two hours each.

3: Negotiate the purchase. Theres a lot of secrets that physicians dont know about. For example, do you have to do each upgrade?

4: Involve your patients in the decisions and keep them informed. Patients are used to being treated a certain way, and if you start to do it differently, patients will think you dont know what youre doing.

5: Make sure everyone knows what everyone else is doing. In small physician offices, Hartley said, the physicians that lag behind the first adopters often turn out to be the strongest users.

Ed Jones chair of Workgroup on Electronic Data Interchange, is a co-author of the book, which is being published by AMA Press. Outlets like and are expected to begin selling the book in January. It can also be ordered at EHR Physicians.

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