Despite the fact that a third of CIOs are encountering ‘significant pushback’ from specialists who’ve been asked to use primary care-centric EMRs, and that almost 60 percent feel those physicians are justified in their displeasure, the vast majority of CIOs (70 percent) do not support the use of departmental solutions. In fact, 60 percent of CIOs expressly state they are endorsing the ambulatory component of their acute EMR for all practices under their purview.
(SnapSurveys are answered by the healthsystemCIO.com CIO Advisory/Survey Panel. To see a full-size version of all charts, click here. To go directly to a full-size version of any individual chart, click on that chart)
Do you influence or direct EMR selections for specialty ambulatory physician practices?
- Yes – We already have a single EMR system and do not support others. We try to work with them to customize wherever possible.
- Yes – We provide a single ambulatory EMR, but recognize that this will not meet the needs of all specialty areas, particularly in procedural areas.
- Yes – For our multispecialty group only.
- Yes – We have preferred pricing with several vendors.
- Yes – Influence. In California, you can not directly employ physicians and thus direct them.
- No – Most of our specialists are community, private physicians.
Have you encouraged or decided upon use of your acute EMR vendor’s ambulatory offering in those specialty practices to facilitate data integration?
- Yes – Encouraged.
- Yes – We use Epic for all ambulatory practices and inpatient.
- No – We implemented an ambulatory EMR before we selected an acute care system. We don’t intend, at this time, to go back and replace the ambulatory EMR, as it is working satisfactorily. In addition, we see the future as requiring us to interact with various ambulatory EMRs used by outside physician groups.
- No – We have not because of physician pushback.
- No – We are under evaluation as to what will be our formally endorsed ambulatory solution for hospital-owned clinics. For physician practices, we have three that we endorse.
Have you experience significant push-back from those specialists on the use of that product, mainly because they feel it was designed for primary care, and does not sufficiently suit their needs?
- Yes – Some specialists more than others.
- Yes – The specialist are correct. Most ambulatory EMRs were built with primary care workflow in mind. What works in a primary care office will be totally unacceptable in a busy surgical practice. Note however, that this can often be more about careful design of the workflow rather than needing completely separate systems.
- Yes – Some. It is the stereotypical, ‘I need the Cadillac to do it all’ model…others realize that one which covers 85% is pretty darned good.
- Yes – The product was included in the selection process but eliminated from further consideration after round one.
- No – I would say there has been some pushback, but it is not significant.
- No – Epic has done a nice job providing functionality to specialty areas. Surgery and Ophthalmology were the most challenging.
- No – I would not frame is as significant pushback, but interest from some specialists in specialty-specific software.
Are you considering supporting the selection of a specialty EMR for those specialists?
- Yes – We recognize that the enterprise ambulatory EMR is the repository for the complete patient-centric medical record. We require that it be used for certain shared functions such as a single problem list, med reconciliation, and e-prescribing. However, we recognize that it will not meet all needs and so will implement specialty-specific systems that integrate.
- Yes – We ARE ENCOURAGING SUPPORT OF A SINGLE VENDOR SOLUTION FOR ALL community providers, both primary care and specialist, but that is not the same vendor as our acute care EMR vendor.
- No – Except in a rare situation.
- No – We are currently exploring ways to utilize the specialty “parts” of other software or the content from those system within our core ambulatory system.
Do you feel specialists who voice dissatisfaction with using primary care or generic EMRs have a sound basis for their complaints?
- Yes — Within reason, yes. A balance between the benefits of integration and the necessity of specific functionality should be the go-forward approach.
- Yes – You need to spend more time with design and build in these areas. The primary care implementation approach doesn’t work for specialty areas.
- Yes – The specialists are correct in that not as much thought has gone into supporting their areas. However, we must make sure that specialists don’t retreat into their own “information silos.” For example: You are a specialist in a busy dermatology practice. You perform med rec as is required. Your patient tells you that he is not taking his antiarrythmic medication for some reason. Do you tell the cardiologist? Let him discover on his own? Or worse, the patient goes to the ED in afib?
- Yes – We need to have a robust offering that can be used by a wide variety of specialists.
- Yes – It would be helpful if the major vendors could develop a generic system with some capability to add on specialty items that fully integrate.
- Yes – But, as in most things, it is an ‘on balance’ concern.
- Yes – Actually Yes and No. Until there is specialty-focused content, they have a point. The specialty focused software that we’ve seen is differentiated by the content. Our hope is to leverage that content and maintain the integration without duplicating data or managing a multitude of interfaces.
- No – Most of these ancillary EMRs have a lot of flexibility and/or specialty templates and workflows, so we can fit most situations.
- No – Many systems are flexible enough to accommodate specialists needs … they just may have to be built from the ground up if they don’t come with the “starter kit.”
- N/A – So far, we have been able to meet the majority of our specialist needs w/various cfg settings. The hardest to date has been hemoc. We may need a more specialized product for them.
- N/A – We work to tailor templates in support of the specific specialty. We would like more flexibility in design to minimize the “click count,” yet we have been successful in most cases.
- N/A – Depends on the EMR. The other question is how much of the dissatisfaction is with the implementation, not the software?