EMR systems provide many benefits. In addition to cutting claims and billing costs, they improve patient care by significantly reducing medication or lab test errors that result from sloppy physician handwriting. Such systems also check for drug allergies and adverse interactions with existing prescriptions, and they can advise physicians on what test or procedure is most appropriate.

Even so, they're a hard sell. Many physician practices have only a handful of doctors—some only one or two—and they don't always see the financial point of investing in the EMR system. Between networking costs, converting paper records to electronic records, linking or replacing existing office systems and some lost productivity while everyone learns how to use it, installing the system costs somewhere between $5,000 and $10,000, according to Glaser. That's a lot of money for a small office, and while EMRs will eventually boost productivity, even Glaser admits that there isn't an ROI. "In our best case it is right on the edge of break even," he says. "Our hope is that the vision is enough to push it over the edge."

But every time something goes wrong with the system, that vision of the future moves farther away and Glaser's job gets harder. The CIO is the first to acknowledge that solving the mystery behind the recurring EMR system slowdowns and restoring the faith of doctors and administrators was a major test of leadership for him. "If [a problem] goes on too long, it erodes the trust that your community has in you," Glaser says.

No Quick Fix

By the first week of August, it was clear to Glaser that something was wrong with the EMR system. On Friday, Aug. 6, after the system had experienced outages and slowdowns almost every day for two weeks, Glaser realized the status quo was no longer acceptable. He assembled two key groups for a meeting—the people who touch each of the organization's systems on a daily basis and the IS people who work on the hospital floors.

"I wanted to hear from a technical point of view everything that had happened," Glaser recalls. "I also asked the people on the front lines, What does it look like for the doctors? How disruptive is this? I needed to know what it feels like to live with this."

What Glaser heard wasn't reassuring. The doctors were growing restless. The outages compromised their ability to treat patients. And there wasn't a quick fix looming. Glaser's IS staff identified multiple reasons for the disruptions. The largest single culprit: A server that supported the EMR system kept crashing. Other times, it seemed as if the EMR database had outstripped its capacity. Still other times, an unpatched memory leak in Internet Explorer was the cause of the outages.