ATLANTA – "A tough sell." That is a very succinct characterization of the current environment for marketing of healthcare information technology (IT) – and especially the electronic medical record (EMR).

The characterization was provided by one member of a panel presenting at a healthcare IT "summit" held here this week. It appeared to capsulize the view of the entire panel and, if accurate, casts a rather large shadow over future prospects for IT adoption in U.S. healthcare.

Sponsored and hosted by the Technology Association of Georgia (Atlanta), the summit probably raised more questions than answers in attendees' minds concerning how to make the healthcare IT "sell" easier. The panel specifically focused on the uphill prospects in the U.S. for transforming the broad use of a comprehensive EMR from vision to reality.

Some surveys have pointed to EMR use by as few as 5% of the nation's physicians, with that percentage heavily skewed by smaller practices where their use is very limited indeed.

A somewhat heftier figure was offered for the state of Georgia by panelist Bob Addleton, PhD, president of the Medical Association of Georgia (Atlanta).

Addleton reported that a survey by his association found that 15% of respondents said they are using an EMR, but he offered that figure with a variety of qualifications.

The survey population was self-selected, he noted, since the survey was conducted by e-mail and thus represented those physicians who already had at least some minimal computer expertise.

Further, he said that interpretation of the survey had to assume truthfulness in reporting and that the systems described were true EMRs – both requiring "grain of salt" acceptance, he suggested.

Considering the 85%, or more, of non-EMR users, Addleton put the key question concerning the EMR rather bluntly: "Why ain't more of it in doctors' offices?"

His answer was several-fold.

Physicians, he said, don't have the time, capability, expertise or "inclination" to embrace IT; they don't have enough trusted and reliable information concerning the best choices; and vendors haven't taken the time to understand the actual needs of physicians.

Physicians "haven't related IT to patient care issues or how it can help them do a better job of what matters to them," he said.

Further barriers are the initial and follow-on costs, Addleton noted, adding, "Physicians, by and large, are not known as canny business people for understanding the deep financial aspects of their practice."

Still another issue he cited was the proliferation of vendors – with more than one member of the panel citing a figure of at least 800. And Addleton noted that, when you have too many choices, "more is less."

"How do you even narrow it down?" he asked, comparing the process to shopping for jeans at the GAP, expecting an easy choice of one, but faced with an explosion of styles and types.

Pitching in with still another negative for the sector was Jeffery Daigrepont, principal of The Coker Group (Roswell, Georgia), offering – Bill O'Reilly-style, he said – a "no-spin" talk on the subject.

With Daigrepont noting that his company has no affiliation with any vendors and therefore can offer an entirely independent view, he said that many physicians and physician practices had been victimized by EMR and IT vendors.

"Part of the reason why the industry is so reluctant to adopt [is] they've been taken advantage of," he said. So they have become understandably wary and find it difficult to make a selection.

In the extreme, he said that for many individual physicians and practices, selection of an EMR or other important computer system looms as "a career-defining decision that many are reluctant to make."

Additionally, Daigrepont said that the software chosen, though it may work properly, often is the wrong kind for the practice and thus represents "a lot of poor planning, poor processes."

Under this category, he said there is often little groundwork or training prior to install, citing the case of a neurology practice that, with its initial buy, contracted for 22 tablet PCs but offered no training on how to use them.

"Two docs did go live," he said. "The other 20 physicians gave the tablet PCs to their kids to play with."

Daigrepont offered a Letterman-like list of 10 mistakes "in making IT decisions":

  • Not using a structured process in making the choice of products.
  • Not defining the needs that the system must satisfy.
  • Hiring a consultant who is really a reseller.
  • Paying too much attention to a system's bells and whistles.
  • Not including key users in the selection process – "Psychologically, everyone needs to embrace the system" chosen, he said.
  • Buying more than you need.
  • Allowing vendors to drive the process.
  • Allowing the "powers that be" to choose the system, rather than those who will use it.
  • Confusing the salesperson with the product.
  • Not using a request for proposal process.

Daigrepont acknowledged the fairly stiff up-front costs to install EMRs as well as the often unplanned-for downstream costs of support and maintenance. But he qualified this negative with a key comparison.

The EMR "is expensive, absolutely, but so is your paper system," he said. "Just watch the process unfold with a missing [paper] chart – it can shut an entire business down, bring it to a screeching halt. One person interrupts two to three others who can't really help."

On the positive side, he offered a short list of tips to guide those seeking to purchase an EMR.

  • Require the selected vendor put its source code in an escrow account, in case the company goes out of business.
  • Pursue an "EMR-lite" strategy, meaning an incremental or phased-in approach to adopting the system and then integrating it with the organization's other systems.
  • Take enough time to make a solid decision.

"Time is on your side," Daigrepont said. "You will have up to 10 years of regret for making a quick decision."

Next: EMRs and the Emory effort.