I recently met with some colleagues: doctors who practice Neurology and Family Medicine, who have not yet been to EMR. There are two main reasons for this:

1) They don’t know where to start. Several of your friends have tried unsuccessfully to implement EMR in practice. In most cases, it was a great effort; some teams gave up as time went by and others went down for the count. Some lost money and time on the project and then asked ‘no more’.

2) The failure rate among electronic medical record projects is estimated to be between 30 and 50 percent. At first I was surprised by this high rate. But, by asking, will you find someone who has had a bad experience, or someone who has. It is difficult to calculate an actual failure rate, especially when determining the difference between churn (an interruption in use of the EMR system or an actual failure) that is often reported by a software vendor.

Regardless of whether a situation is called “true” abandonment or failure, the result is the same: money, time, anguish, and a practice that relies on the exclusive use of paper graphics.

The main causes are divided into a few main areas:

Lack of commitment or leadership

Is there a champion doctor in your practice? Medical groups need to reach consensus and keep things moving, and without this, the slightest blow can have serious repercussions. The champion does not need to become an enthusiastic supporter of EMR, but must accept the project. Once a staff begins to feel a lack of unity among the top level, things can start to fall apart, with divisions in different fields, either for or against EMR.

Ultimately, if the project fails, the entire team fails, not just the person who initially championed the cause. There is a possibility that a riot will spread among the group. There could be a single doctor or staff member who is deliberately thwarting the project. They could be sowing doubts among neutrals or trying to escalate troublesome situations. The champion must discover and reorganize these influences before they get too far into the organization. The champion must also make sure the lines of communication are working, with meetings scheduled before and after a date to go live, so that a system can be quickly fixed before a particular user becomes frustrated and gives up.

Poor planning and implementation

This category covers the entire gamut, from hardware and software issues to configuration design and deployment implementation. Either there should be an IT staff member on board, or an outsourced technology consulting firm should be involved in both planning and implementation. This could include planning, planning training, as well as the product design and implementation stages. There should be a dynamic schedule or other work breakdown structure in place to keep things going. A simulation day is another real test. Together, these components promote success, especially in a crisis. Expect to have at least one.

The Internet Technology Advisor can also help with network hardware purchases, while trying to control overall system costs. Of course, that doesn’t recommend buying cheap stuff either. Controlling the costs of physical infrastructure can work against you in the end. Unless your office is small, consumer equipment available in retail stores may not be advisable. Get and stay current on service and maintenance agreements, including backup servers and switches. Failure to do so could reduce the effort of your practice.

Without purpose

Some electronic medical records projects are in trouble early on. If the goals for the future system are not described or understood, the chances of a successful plan being formed are low. Unrealistic expectations and unclear goals further reduce your chances of success. Often times, practices that do not maintain a clear understanding of the situation or do not enlist the help of an expert could have avoided the problem to no avail. What do you want the EMR system to do? If you are not sure what you ultimately want, you will not be able to understand what the EMR system needs. If you get caught up in some software system in a meeting at the Academy, but without first understanding the product or the company.

Change management issues

Ask any expert who deals with the implementation of large technology projects. No matter what industry or business area, everyone talks about the “people factor” as one of the main causes of project failure. Electronic medical records are no different. Many new doctors have grown up with the technology, even training with institutions that already use an EMR system. They won’t miss a beat. The same is true for younger staff members accustomed to social media and texting. But some of the older doctors have to make a bigger adjustment. They may even have used the Internet recently or suffer from technophobia. Resistance to technology can show up in many ways, including rejection and withdrawal. Providing these employees with the proper training, preferably from their coworkers, is key to avoiding a learning curve that is too steep to achieve before start day.

Some of the older staff members may need substantial training. A process must identify those who are lagging behind and require further training. Your practice cannot afford to lack the critical involvement of staff or the lack of skills necessary to implement a project successfully.

Workflow processes are also involved in change management. Inefficiencies in patient care will only be exacerbated on a digital platform. The go-live date is not the date to find out that the new EMR system is not living up to the way it has always done before. Proper technical planning can also help ensure that there is a proper “fit” between the needs of the practice and the EMR solution. This can mitigate failure factors such as unrealistic expectations about how long it will take for the EMR to function properly, lost productivity in the clinic, and inappropriate customization. All of this can lead to abandonment of the software system and a perpetual search for the ‘perfect’ EMR solution that is never done.