Where should I begin? We often wonder this, and especially so if we have friends or colleagues who have tried but were unsuccessful at implementing EMR. Most of the time these are strong efforts conducted in earnest, though at others the firms were just going through the motions. Some teams quit as time wore on, and others were knocked out of commission. Some lost time and money on their attempts, then decided they were done.

About thirty to fifty percent of EMR projects fail. At first, this high figure surprised me. Then, when asking around a bit, I'd talk to somebody who'd had a bad time, or knows someone who has experienced failure. Especially when trying to calculate the failure rate, it becomes difficult to discern between a 'true' failure and an 'abandonment.' The latter is the case when the staff simply stop using the system or trying to implement it. Of course, whether it is called a true failure or an abandoned project, the result is similar in terms of lost time, money, heartache, and a practice which then still needs to fall back into reverting to paper medical records.

Here are some primary causes of EMR implementation failure:

Not Having a Clear Purpose - Some EMR projects are in trouble from the start. If the future goals for the system aren't described and understood, the chances of forming a good plan drop. Further, dreamy expectations with unclear markers further reduces the chances of survival. When practices don't keep a clear watch on the situation, or fail to get quality help, could have avoided the problem of having no purpose. What is it that your practice wants the EMR system to do? If unsure about what you want, ultimately, you won't understand what the EMR system plan needs to thrive.

Poor Plan and Implementation - This covers the whole gamut, between software and hardware issues. This category covers the entire gamut, from design and set-up, hardware and software issues, to roll-out into implementation. There should be either a dedicated IT person on-board with the project, or an outsourced consulting firm to assist with the plan and implementation. This assistance could include training planning, product design, and the stages of implementation. This category covers the entire gamut, from design and set-up, hardware and software issues, to roll-out into implementation. Some work breakdown structure must be in place as well, to keep things running on track. A live simulation day is another important threshold to pass successfully. Together, these are the components that allow for success, particularly in crisis situations. You should plan to experience a few along the way.

The IT advisor is able to help with hardware purchases for the network, meanwhile helping to keep the overall costs acceptable. I don't recommend trying to squeak by with the cheapest technology, either. Trying too hard to control infrastructure costs can backfire in the end. If your medical practice is smaller, it may not be advisable to purchase consumer equipment commonly available for sale at retail. It's important to gather and maintain service agreements, including back-up servers and switches.

Problems with Change Management - Anyone expert in dealing with proper implementation of IT projects will tell you. No matter which industry or area of business we're talking, everyone mentions the human factor as the top cause of failure. EMR isn't any different. Plenty of newer physicians have grown up on technology, even training at institutions which already use an electronic record-keeping system. These people don't miss a beat. Same is true for young people on staff who are accustomed to texting and social networking. However, some of the more venerable doctors have more of an adjustment to make. Maybe they've only started using the Internet recently, and suffer from a technology inferiority complex.

Workflow processes are also involved in change management. Inefficiencies in patient care can only be exacerbated on an electronic platform. The go-live date is not the date to discover that the new EMR system doesn't live up to the way they've always done it before. Proper technical planning can also help ensure there is proper ‘fit' between the practice needs and the EMR solution. This can mitigate such failure factors as unrealistic expectations about the time it will take to get the EMR working properly, loss of productivity in the clinic, and inadequate customization. All of these can lead to abandonment of the software system and in a perpetual search for the ‘perfect' EMR solution which is never realized.

The resistance to new technology appears in several ways which include withdrawal and refusal to participate. Providing the necessary training for these staff members is key for preventing a learning curve from being too steep to be accomplished before the launch date. Some older workers could require a lot of training. The training plan needs to identify those who are trailing behind or require more help. For the simulation day, you will need the ready skills and group vested interest in success in order to successfully implement EMR.

Lack of Leadership or Commitment - Do you have a doctor to champion the project at your office? Groups of physicians must reach agreement and keep things moving along at a healthy pace; otherwise, even a small glitch and send things down the wrong path. The champion doesn't have to be the most enthusiastic, but they must have expressed buy-in and a commitment to the project. When a practice's staff start to feel the dissent coming from above, it could spread bad juju throughout the community. You'll want to avoid a situation when the workplace becomes a place of camps divided.

If the project fails, the whole team fails - not the initial champion of the cause. A mutinous tone could rise up somewhere in the group, either one doctor or another staff member; either way, it is someone who will actively work against the project. The champion needs to find out and re-direct the circumstances in this case, stopping it there before the influences travel too deep into the organization. Communication lines should be functioning well, with meetings scheduled before, during, and after the date of EMR launch. The system must change to address a problem before users start to become de-motivated and give up hope.