Applied Medical Informatics for the Chest Physician: Technology
It is intuitive that the introduction of an EMR into a large academic health system will differ in many ways from its introduction into a small, community, private practice office. However, what may not be as evident is that the characteristics of these different clinical environments may have more to do with success than simply scale alone. That is, in clinical settings where there is a well-established tradition of clinical groups working cooperatively with one another (eg, a typical office practice), there is significantly greater acceptance of a change, such as the introduction of an EMR. Conversely, where there are settings in which there is a discrete group that is expected to bear the brunt of the change resulting from the EMR introduction, tragic failures have been well-documented. These failures may stem from even the perception of the possibility of losing authority or from not being involved in the configuration of the system. so
The time needed to implement an EMR is roughly proportional to the size of the organization being automated. An important consideration, however, is the profundity of the change over time. Experience over the last 25 years has shown that the introduction of an EMR system in a > 200-bed institution should be considered to take the same order of magnitude in time to achieve success as the completion of construction of a new hospital building. This comparison can be helpful in many ways. For example, the disruption that many have personally witnessed on moving to a new institutional setting provides a frame of reference for improving the likelihood that critical support systems, for instance, training and help desks, are correctly staffed and supported to avoid an actual increase in medical errors. It has recently been reported that these errors may be caused predominantly by the too rapid introduction of an EMR into a health-care system.
The entire cost of EMR selection, configuration, and use remains high. There are many reasons to explain this aspect of why most physicians in America are without the use of a complete EMR. As of this writing, almost every aspect of the EMR in this country is nonstandardized. One major consequence of the lack of standardization is increased cost. The costs of EMR implementations (including not only software purchase, but cost of the necessary system configuration, interfacing, and total project costs) vary from hospital to hospital, vendor to vendor, and year to year.