“Make them use it” is not a valid EMR adoption strategy

The biggest risk to EMR implementation projects is usually one that doesn’t receive much attention – user adoption.

Every time I come across a healthcare organisation that presents grand plans to implement a traditional Electronic Medical Record (EMR) system, I am struck with how the attractions of the grand project lead to a dismissal of the risks associated with going on that journey.

Of course we are all aware that a traditional EMR rollout is a huge financial commitment (thus raising the financial risk considerably, in addition to the operational risk of upending the healthcare organisation for a minimum of two years while the project is implemented). In many cases, those risks are well flagged and whilst typically underestimated, they have at least been given strong consideration. However the biggest risk to such a project is usually one that doesn’t receive much attention – user adoption.

This is typically evident when executives are asked “how are you going to guarantee that your clinicians use the EMR effectively?” The stock answer is “we’ll just have to force them to use it!” followed up with references to training programs, change management workshops and other initiatives.

This is not an adoption strategy, for these reasons:

• Clinicians are extremely busy people with set ways of working – consultants typically operate with a high degree of autonomy. They are the most important resource healthcare providers have at their disposal. They do not respond well to being “forced to do something”, particularly where they have had little input into the conception or design of the EMR project.
• Clinicians are extremely busy people – the assumption that they can commit to weeks or even multiple days of system training underestimates the fact that their clinical diaries are effectively booked many months in advance, and that they have typically already committed time for continuing professional development or research in addition to their day-to-day clinical work.
• Clinicians are extremely busy people – finding themselves losing proportions of their clinical day to ensure data is entered onto a system is usually an anathema to them, particularly as they need to take the “leap of faith” that they will benefit from same before seeing the accrued benefits
• There is a network effect – an EMR is of most benefit only if all clinicians are using it and that all relevant data is available electronically and in a timely manner. If that cannot be achieved, then there tends to develop a parallel paper record, ultimately further undermining the integrity of the EMR and leading to lower consultant engagement. 
• Clinicians are extremely busy people – when introduced to traditional EMR’s, facing multiple menus and clunky navigation, they naturally ask “why can’t this be as easy to use as my phone and tablet”? 
• Lastly – in the light of the valid objections, the level of management engagement with clinicians to enforce a “make them use it” approach is such that positions can get entrenched, focus becomes on the technology, rather than the benefits realisation, and trust between the clinical and executive leadership can deteriorate significantly, with profound downstream impacts. 

So, in light of this, what is a strategy that will work to guarantee user adoption?

Well, it might seem obvious, but it starts with the idea of having clinicians wanting to work with the EMR rather than being forced to do so. This ultimately goes back to the technology choice, and how involved and engaged the clinicians are in the selection and review process.

If ease of adoption and flexibility of approach are high on the agenda, the user adoption issue melts away. If ease of adoption and flexibility of approach are high on the agenda, then the selected system can adapt to the needs of the clinicians, rather than shoehorning their clinical practices around the needs of the technology.

Finally, again if ease of adoption and flexibility are high on the agenda, the system should be able to grow and flex as the healthcare organisation needs to grow and as the appreciation of the power of technology grows within the organisation, deepening clinical engagement with technology and giving a platform for continuous clinical and operational improvement.

Now that’s a strategy.

The nuviun industry network is intended to contribute to discussion and stimulate debate on important issues in global digital health. The views are solely those of the author. This article first appeared in Slainte Healthcare's Insights Series, and is reprinted with permission.