Life After a Disastrous Electronic Medical Record Implementation

Abstract

The majority of users of an Electronic Medical Record (EMR) at a family medicine clinic located in a small city in the western United States are currently quite dissatisfied with the system. The practice experienced a disastrous implementation of the EMR in 1994 and has not recovered. Although the level of dissatisfaction varies among the practice employees, several influential physicians are pushing to “pull the plug” and start over with a brand new system. The authors of this case studied this practice during a more comprehensive qualitative study of the impact of an EMR system on primary care. The practice’s negative experience was particularly noteworthy, because the other four practices in the larger study were satisfied with the EMR system. As with most system failures, there are multiple organizational and other factors that have contributed to the frustrations and dissatisfactions with the use of EMR within this practice.

Take Note(s): Differential EHR Satisfaction with Two Implementations under One Roof

“…Whereas implementations such as the Regenstrief Medical Record System have been used effectively for many years, 1 other implementations have been expensive failures. 2,3 Along with cost, barriers such as resistance by physicians, concerns about security, and risk of investing in a product that may not be supported in the long term 4 all contribute to the fact that the majority of ambulatory practices in the United States have not implemented EHRs. [5][6][7] In spite of electronic records' presently low penetration into the ambulatory care environment, their potential benefits to patients in terms of quality and safety cannot be ignored.…”

“…9,10 Mazzoleni et al 11 describe user satisfaction as ''essential to the survival'' of a system. Implementations that have failed 2 or have been plagued with difficulty 3,12 have often been those with which physician-users are dissatisfied.…”

“…A number of studies have identified factors contributing to or predicting user satisfaction with new electronic implementations. 3,[13][14][15][16] Among factors that may affect user satisfaction with computer systems are gender, [17][18][19] age, 11,17,20,21 and computer sophistication or familiarity with technology. 11,13,14,22 For each of these factors, controversies exist about the degree and direction of its influence on satisfaction.…”

Perceived importance of EMR functions and physician characteristics

“…Since physicians must use EMR systems in their day‐to‐day work, the success of an EMR depends to a great extent on their attitude and satisfaction with the EMR system. Many unsuccessful attempts to implement EMR technology have been attributed to the physicians' dissatisfaction with the EMR system (Van Der Meijden et al , 2003; Wager et al , 2002). This is exemplified by several highly publicized EMR implementation fiascos, including one at Cedars Sinai Medical Center in Los Angeles, in which physicians revolted and forced the administration to scrap a $34 million computer system (Connolly, 2005).…”

Using Comparative Cognitive Work Analysis to Identify Design Priorities in Complex Socio-Technical Systems

“…Health care can be classified as a complex-socio technical system by virtue of its characteristics: health care environments have a large problem space, subtle social aspects, heterogeneous perspectives, and a high degree of hazards, coupling, uncertainty and disturbances (Vicente, 1999). Given these characteristics and its categorization, it is not surprising that many health care projects, designs and implementations are prone to fail; the study of these failures are numerous (Gagnon et al, 2010;Heeks, 2006;Kaplan & Harris-Salamone, 2009;Kumar & Aldrich, 2010;Wager, Lee, & White, 2001).…”