EMR adoption

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Significant barriers still remain for adoption of electronic medical records (EMRs) [1]. Minor preparations may greatly aid the implementation process.

Strategies for Improving EMR Adoption

Suggestions for Integration Tools

One organizational suggestion to consider is the changing of the physician entry pathway where initial EMR information is received and application made for health IT services (HIT). Physicians routinely deal with medical staff office personnel through the hospital application and credentialing process. Health IT information should be handled in the same manner. This requires a concerted effort on the part of the medical staff personnel and the IT groups to work together. The goal is not to usurp the critical security and accountability functions within IT, but to move the basic entry application and information acquiring processes to the medical staff credentialing office domain. The initial physician application packets should include everything required to begin the HIT application processes.

Referral system

There should be a referral to the health system web site, if one exists, that includes physician information on what HIT is available within the health system and how to apply for it. The site should also include the digital application request procedure and any HIT training tools. The entry HIT process should be relatively transparent and made similar to functions, locations and personnel that physicians are already familiar with and have established some connection. Since physicians often need many functions such as securing dictation numbers, initiating password requests for PACS, EMR, and network entry and remote access, the process could all start within a good medical staff office.


In the password venue, the development of a single user sign on process, perhaps using biometrics would make the process even more successful in health systems. For teaching programs that have administrative personnel handling graduate physician education application processes, the same algorithm can apply. All of the basic steps for HIT entry level information and application can go through medical education department similar to the mechanism described for the medical staff office. This again requires coordination of efforts and commitment but greater efficiency in the process is gained.

Once physicians become part of active medical staff, there must be a health system commitment to help physicians maintain their HIT proficiency and access. This includes a physician friendly help desk that is responsive and available 24/7. There should be opportunity for physician feedback communication at many levels and modalities as well as retraining opportunities either digitally on a web site or with an on site trainer that can be scheduled.

Office personnel

What is also little discussed is the role played by physician office personnel in the health IT implementation. Although there are efforts being made today to make regional sharing of health records a reality, this is an ambitious and elusive goal with major hurdles yet to be overcome. What can occur today is to realize that these physician office personnel can be additional valuable assets to a successful HIT strategy. Involving physicians offices early and often in any planned health IT implementation or new service upgrades is always beneficial. They are also an excellent source of feedback that may be better than what one may receive from physicians. Educating the staff to understand why their own involvement and that of their physician(s) is important in the HIT project is a key step.

Physician offices need to receive hospital information and reports on a regular basis for billing and their patient office records. If the offices can become connected to your health IT system, this can streamline the information flow processes and cut down on the excess phone calls to the health system wondering why reports are not received. Just like physicians, the offices usually have to request remote IT access and this usually is a difficult process. Streamlining and making the IT remote application process easier for this group is worth doing. Information packets describing the process and contact persons can be shared with office groups through physician office liaisons teams. The application information and digital application itself can be placed on a hospital web site and should have a similar look and feel of the physician HIT application process. Doing a good job on the front end of this process is not sufficient. Physicians’ office staffs have a marginal knowledge base for HIT. Many offices have rudimentary equipment and software that can only do basic claims processing and scheduling. Introducing the idea of allowing them to access their physician’s patient’s information online in a timelier manner is often met with skepticism. In order for this strategy is to be successful, there must be a health system IT commitment to work with the physician office staffs in helping them prepare their office computers to be able to do basic access functions and to help train them on basic privacy, security, and system maintenance issues that can aid their own offices as well as benefit a health system that allows physician office personnel remote HIT access

By having physician office personnel better trained in HIT access and understanding of its functionality can help pave the way for their own office HIT implementation in the future. Do not forget this group in your communication strategy when implementing new HIT systems and communicating changes. Physician office managers can be a valuable educational and reinforcement tool for you to aid in physician education efforts.


  1. Miller RH, Sim I. Use of Electronic Medical Records: Barriers and Solutions. Health Affairs, 2004; 23(2): 116-126.
  2. McDonald, C. The Barriers to electronic Medical Record systems and How to Overcome Them. J Am Med Inform Assoc. 1997; 4(3): 213-221.
  3. Ford E W, Menachemi, Phillips, MT. Predicting the Adoption of Electronic Health Records by Physicians: When Will Health Care be Paperless? J Am Med Inform Assoc. 2006; 13: 106-112.
  4. Baron, RJ, Fabens, EL, Schiffman, M, Wolf, E. Electronic Health Records: Just Around the Corner? Or Over the Cliff? Ann Int Med. 2005; 143(3): 222-226.
  5. Small Physician Practices. Health Affairs 2005; 24(5): 1364-1366.

EMR adoption in small practices

EMR adoption in small practices

Barriers to EHR adoption

Barriers to EHR adoption