One of the largest challenges facing hospitals when it comes to widespread adoption of electronic health records is physician's fear of productivity loss. 
"Physicians are frequently reluctant to migrate to an EHR simply because they are already optimized within their current system and any deviation from this brings in a sense of uncertainty and the possibility of inefficiency," says Bud Lawrence, MD, an emergency medicine physician and IT physician champion at Henry Mayo Newhall Memorial Hospital in Valencia, Calif.
The concern over lost productivity is especially acute in the emergency department. "There's definitely been an impact on efficiency," says Travis Brown, DO, emergency department medical director at Duncan (Okla.) Regional Hospital, of the hospital's recent transition to EHRs. "When EHRs are adding five to 10 minutes per patient, and when you're seeing three to four patients per hour in the ED — the impact on flow just isn't sustainable," he says.
The two physicians offered several best practices to both mitigate operational inefficiencies of EHRs and help facilitate physician adoption.
1. Understand the problem. "The problem now is that EHRs largely just aren't very good," says Dr. Brown. He says that government mandates for the adoption of EHRs have led to a market of hurriedly-developed software that has not reached peak functionality. "The software hasn't grown into its own, it's just been forced out into the market," he says.
"It's like baby birds," he says. "At some point, mama needs to push the baby birds out, but if she does it too soon, they'll die… and right now, [in the EHR market] we're just seeing a bunch of dead baby birds."
Dr. Brown believes EHRs will improve in the very near future: "EHRs will eventually make our lives better," he says. "Before I'm done practicing medicine, the day-to-day will be much easier."
For the time being, however, he says hospital administrators should understand current shortcomings and look for ways to make the transition to EHRs as easy as possible for physicians.
2. Focus on usability, not dollars, when selecting an EHR system. Both Dr. Lawrence and Dr. Brown agree that getting the most efficient, user-friendly EHR system is worth any additional expense. "Usability trumps most everything else," says Dr. Lawrence, and is worth paying for.
"Smartphones and tablets, for example, are cool and useable and people can't put them down. Why shouldn't your EHR be the same?" says Dr. Lawrence. "Apply resources to achieve this usability prior to go-live, even if the amount of resources seems massive. It will pay off in the end."
Dr. Brown recommends hospital administrators "not let dollars be a determining factor" when deciding which EHR system to purchase. Because of the variability in quality among systems, "hospital CEOs have to do their due diligence to find the best EHR for their hospital," he says.
"Remember, you get what you pay for," Dr. Brown reiterated.
3. Consider separate, department-specific EHR systems. As an alternative to hospital-wide systems, Dr. Brown suggests EHR systems that are tailored to meet the specific needs of each department. "Using software specifically designed for one department adds complexity for the IT folks but increases efficiency" for the department in question, he says.
Duncan Regional's emergency department uses T-System's EV, which provides Dr. Brown with relevant information like number of patients seen that helps him staff and run the department, he says.
"Don't be afraid of custom solutions" like ED-specific systems, to meet the specific needs of each department, he says. "The additional cost and IT expenses will lead to better productivity down the line."
4. Invest in additional technology solutions to ease the transition. Dr. Lawrence's emergency department was efficiency positive 60 days after implementing its EHR system, partially in thanks to additional technology that helped solve operational inefficiencies. "Our physicians have seen increases in reimbursement," and thanks to the use speech recognition software, "they are leaving their shifts on time rather than staying two to three hours later to complete charts," he says.
"Physician satisfaction is at an all-time high and we are still trying to find ways to make small adjustments to further increase throughput and maintain our high quality measures," says Dr. Lawrence.
5. Find (and compensate) a physician champion. "It is critical that hospital administrators identify a physician champion," to aid EHR adoption among physicians, says Dr. Lawrence. The physician champion should be "someone who is energetic, has excellent interpersonal skills, understands IT and the project as a whole, someone who is vested in seeing the hospital and the project succeed, and most importantly, someone who is willing to put in the work to make the EHR great," he says.
The physician champion also has to be closely involved with both administrators and the IT committee, "be there when decisions and changes are made," says Dr. Brown, and serve on any IT advisory boards.
Dr. Lawrence adds that the physician champion needs to be compensated for his or her extra effort. "They are unlikely to provide the hours necessary without some element of reimbursement," he says.
More Articles on EHR Adoption:
How the ONC is Facilitating EHR Adoption at Smaller Hospitals
Top 10 States for EHR Adoption
7 Best Practices to Combat EHR's Unintended Consequences in the ER