Caveats when Changing EMRs

As more and more clinics are leaving their old EMRs and moving to Praxis EMR, we are experiencing new challenges that we would like to share with you. One such challenge is very subtle and particularly important; it has to do with the process of change itself.

We'd like to explain with a personal story from Richard Low, MD, Praxis EMR Founder and CEO:

"My Love Affair with Microsoft Word" by Richard Low, MD

Let me say at the outset that I am a Microsoft Word fanatic. I admit it! And I use the word correctly:

I am a true "fanatic."

Therefore, I understand and truly appreciate the many clients that feel exactly the same way about Praxis EMR. I believe that Microsoft Word is the best software I have ever experienced, and that includes our own software (of course, I am not currently practicing Medicine as I did for 20 years!).

Yes, people often chuckle when they hear the CEO of Praxis EMR touting the wonders of "his MS Word" and what he is capable of doing with it, which brings me to my story.

I purchased my first computer in 1989—a clone with a 286 CPU. I had previously rented an even more primitive computer (an 8086) before I decided to "take the plunge." This simple machine did not come with any programs installed, so I bought a book on TurboPascal, a programming language, and I wrote my first little program (Tic-Tac-Toe). I was hooked!

I have never programmed anything in Praxis EMR. For that purpose we have a highly trained development team. But the ability to work with macros, first in WordPerfect, and then in MS Word has helped me to interpret and translate the medical needs brought up by our wonderful clients into a language that our programmers understand.

Of course, in addition to the joy of working with Praxis, I had to write business letters as well, so I bought my first real word editor called WordPerfect. I really liked WordPerfect and tried to see how I could make it generate clinical notes for me (back then I actually practiced medicine, for 20 years no less) but I quickly found that the template macros did not perform to the level my practice required. Yet, I loved the macros in WordPerfect. The whole system felt comfortable to me and was highly useful—it automated dates, headings, end salutations, envelope addresses, and offered many more time saving tasks.

That is when I spoke with Thomas Curran, a good friend, West Point graduate, and CEO of his own software company. One day Tom asked me: "Why are you not on Microsoft Word?" I did not even know what "Word" was, but of course, I abandoned my beautiful WordPerfect macros in favor of this newer application that was touted to be so superior.

As I began using MSWord, or better said, as I TRIED to use it, I encountered countless problems. Everything that I found so useful about WordPerfect was simply not present in Word…or so it seemed at the time. The macros did not work the same way; the program did not behave the same way; the whole experience did not seem intuitive. In essence, Word seemed like a fiasco and a complete downgrade nowhere near as good as my old WordPerfect.

I felt betrayed!

I angrily went back to Tom and said, "Tom, what did you make me do? This Microsoft Word is garbage!" Thomas smiled and patiently recommended I purchase an independent book on MSWord, rather than learning from the Microsoft manual. It is amazing to me, but software companies, are notoriously inept at writing excellent manuals. Microsoft is a multibillion-dollar company that hires the best writers in the world, and yet their manuals have never seemed very useful to me.

So I purchased a wonderful book from the QUE Collection, an excellent library of how-to software manuals. The author, began to guide me through the programming of MS Word. I entered another dimension- a wonderful dimension. I was programming for real, or so it seemed. I slowly but surely began to change my mind about Word, as I became aware of the genius of Visual Basic for Applications that was built into it. I created macros that I could only dream of having with Word Perfect. I began to appreciate the brilliance of the program, the subtlety of it, the power of it.

Today, "my Word" is not just a simple text editor, but rather a critical application that handles a good part of my business life. It is my database; it sends my emails automatically, reminds me to make phone calls, maintains my agenda, and features a calendar with built-in alarms and a most sophisticated "to do list" I have developed from experts. In short, it is a business manager's dream, all in one application. People who come to visit me and see "my Word" at work cannot believe what I have developed.

Our programmers laugh at me, of course. To them, this is not "real programming," and they are probably right, but it feels great anyway. Of course, in many ways "my Word" is not Word, as I have transformed it slowly but surely over many the years into a dream business application that saves me many, many hours of work, does the work of several assistants, and makes me a far more effective business person. Yet I still program it. I still improve it, weekly. I find the task relaxing and enjoyable, and it is one of those pleasures that I savor for the weekend.

The question is, why did I dislike MS Word so much initially, only to praise it so much today?
The answer, of course, is not found in MS Word, which did not change much in its essence, but in myself. When I first started Word, I had pre-set expectations and biases from by my previous experience with WordPerfect that naturally I thought were NORMAL. Of course, there is no such thing as "normal" in software.

The experience of a new user of a powerful software application is never the same as that of a seasoned user. The truth of this statement is compounded many times when the new user has worked on a similar type application in the past, and has developed ingrained habits and expectations over months or years of use. These old habits get in the way of learning the new program. Fingers move automatically to expected locations only to experience disappointment and frustration when things are not where they are "supposed to be," or do not work the way one anticipates. It is only after relearning that we "re-wire" our semi-conscious habits to take full advantage of the new system. Only then is an immense pleasure experienced with a good product. At Praxis, we call this "the Eureka moment," the moment the user finally "gets it!"

Thus, if you have used another EMR application prior to upgrading to Praxis EMR, you need to be open minded until your habits are "re-wired" to work with Praxis. Praxis is NOT like your old EMR. It is far more powerful. Take the time to find out how Praxis does things and you will see something amazing, as I did with Word.

Although sometimes change does not come easily, the effort and rewards of Praxis EMR are definitely worth it! So take it slowly and work closely with our excellent trainers. Be ready to lean new approaches and improve upon old habits. You will find that Praxis EMR will take your practice to a new plateau, where you will benefit professionally and financially for a lifetime.

Richard Low MD
CEO, Praxis Electronic Medical Records

• 1 Praxis has an external book written by Doctor Steven Gold, MD MPH, a long-time Praxis user ("The Magic Of Praxis"). It is a wonderful addition to our Praxis extensive documentation.