Why Doctors Fail to Implement EHR

With businesses across the globe pursuing continual advancement in business technology to improve efficiency, obtain advanced business diagnostics and prevent errors, attention must be paid to the causes behind the slow integration of health information technology into the U. S. healthcare system.  The topic is being forced as healthcare organizations are required to be operating on a “complete” electronic medical record by 2015 based on the timeline of integration laid out in the HITECH Act of the American Recovery and Reinvestment Act.  While organizations will eventually have to move from the paper charting system which has been in place for the entirety of modern medicine, the question as to why organizations continue to drag their feet throughout the process of implementation must be addressed.  There is a well laid out timeline with milestones and financial incentives for integration of a medical organization in to a complete EMR, so a claim of ignorance is no defense.  
In a survey of EHR use that explored the barriers to implementation, the most cited reason that organizations were delaying was a lack of capital for initial purchase followed by concerns regarding the ongoing costs of maintenance.  74% of respondents stated that the upfront costs of purchasing an EHR and the associated costs for upgrading infrastructure were beyond the resources of the average 5-7 practitioner organization.  The next cited concern was the cost of ongoing maintenance, with 44% of those responding saying they were unable to afford the ongoing costs including tech support, licensing fees and staff training that an EHR requires.   A study out of Dallas estimates the cost for a 5-physician practice at $233,297 for the first year, with average per physician costs of $46,659.  With many primary care physicians operating in single-practitioner clinics, that cost can amount to a 30-40% cut in reimbursement.  
Beyond the cost barrier stands the less mentioned but more important issue of physician/organization resistance and inability.  Regardless of the cost or availability, if the organization is unwilling or unable to manage the transition to an electronic system, the process will not happen.  For the small physician practices, it is incredibly unlikely that there will be a staff member present who is tech-savvy enough to critically analyze the multiple options and select the most appropriate EHR program.  With medicine becoming ever more complex, it is unlikely that the majority of physicians, who completed their education long before the computer age, will be able to learn the finer details of EHR implementation while also staying up to date and current on new medical practices, which is their primary responsibility to patients.  The answer to this conundrum lies with us in the health technology field.  
We recently spoke with the chief of medicine for a healthcare system that employed over 110 physicians and practioners across multiple specialties.  Their clinic system was progressing through the transition to a popular electronic medical record, and he was lamenting the lack of expertise and computer experience throughout the hospital staff.  Throughout the course of our conversation, this physician with years of education and experience stated that the process was “the blind leading the blind” because of a knowledge vacuum in the organization when it came to navigating the multiple decisions involved in EMR implementation.  
If the chief of medicine at an organization of this size was realizing the difficulty in the transition, how much more difficult is it for small practices and single-physician groups? The transition process of converting a patient’s history from paper to electronic form is difficult enough.  Add in a practitioner whose time is stretched thin without technologically savvy staff to guide the process, and it is small wonder why those practitioners are choosing to put off the transition to another day.