One in three attempts to implement an electronic medical record (EMR) will fail within a year, according to some US estimates. The head of a 60 physician practice in Nashville, TN, recently gave his analysis for how and why an EMR implementation can go wrong and fail. Mark Grasela, CEO of Heritage Medical Associates spoke at the recent Healthcare Information and Management Systems Society conference in New Orleans, the largest health IT conference in North America.

Dr. Grasela's seven reasons for failing at EMR implementation:

• A unilateral vision. In anything but solo practice, some degree of consensus must be reached among the physicians in the practice on the type of EMR to installed. Trying to impose one viewpoint on a group practice is a recipe for failure.
• Less than full organizational commitment. Unless all physicians in the practice are committed to the vision of an EMR there is a good chance implementation will fail. One hundred per cent organizational commitment is needed to making this major decision.
• Failure to define current workflow. Unless you do a good job of defining how work is currently done in your practice, an EMR is unlikely to improve workplace efficiency and can have the opposite effect.
• Expecting the EMR to fix everything. If there are staff issues or workflow problems in your practice today, implementing an EMR is not going to fix them and will probably exacerbate them
• Picking the wrong product. It is important to find the EMR that fits the way you practice and a company that shares your vision because you are likely to be working with them for a long time.
• Poor training/support. Unless all physicians and staff are properly trained they are unlikely to realize the full potential of an EMR and without extensive support during the implementation stage those using the system are likely to become frustrated and disheartened and stop using it.

More detailed practical information on successfully implementing an EMR will be presented in the spring edition of Future Practice magazine, scheduled for publication in June.