Are Scylla and Charybdis the Only EMR Implementation Paths?

No.... the 2 sea monsters that Homer described in the Odyssey actually offered Ulysses an enviable situation compared to what today’s physicians assume they face when implementing information technology. The latter seemingly have perceived they must choose a path between one of about 6 monsters. At least with Ulysses, it was only an either/or between Scylla or Charybdis.
There is much angst out in the real world of real doctors actually attempting to deliver care. There is some degree of awareness that current, fee-for-service, volume-based healthcare models will be waning soon. However, future, ”value-based” models (PCMH, ACO, P4P, MU, PQRI, etc.) are little more than unfunded or underfunded alphabet soup at this point. Regardless, there is increased awareness that the future will require dramatically different practice resources based on different information management strategies. The comprehensive EMR usages required for this transformation have been elusive. Only 4-6% of current EMR implementations can meet the requirements, and these typically have up-front costs of $30-80k per clinician. Currently, 20-40% of installed, comprehensive EMRs are subsequently de-installed. Then, add to this that over 50% of comprehensive EMRs that are not de-installed have been implemented in such a fashion they are arguably doing more harm than good with the doctor having to pick between paths that often lead to monsters:

• Doctrolus - This one turns clinicians into distracted data trolls when seeing patients.
• Enslavus - This witch forces clinicians to spend huge chunks of their life, when not seeing patients, feeding her with data.
• Hemsucus - This blood thirsty monster trickles away clinician's productivity life blood.
• Rubishus - A frightfully ugly beast forces clinicians into “Documentation by Exception” which is the auto-entry of a bunch of default, normal findings which creates a lot of garbage. This is probably the most egregious monster as it has forced the widespread proliferation of… “canned” notes. Today, any clinician caring for patients will relate frustration about having to access medical records that contain 90% canned garbage. This makes it difficult and sometimes impossible to get to the useful 10%.

Understandably, a majority of clinicians have either found none of the comprehensive EMR implementation-methodology monsters, above, to be acceptable (so they often bounce around among them), or chose a less comprehensive beast, below. Many clinicians are just now beginning to awaken to the reality they will likely have around a 30% income differential in 2-3 years, and lose “quality” status due to lack of information technology capability. However, most of them are waking up only to choose one of the following:

• Alchemus - This ghoul preys upon clinician's desire to at least get started, so she deceives them into using an EMR as mainly paper-behind-glass (e.g. choose a “simple” EMR product, continue transcription, or move to speech recognition, etc.) that is unable to adequately collect and manage the data to practically meet forthcoming meaningful uses, PCMH, etc. Doctors just hope that some day, some how, some way, their records can magically morph into real data... easier to turn lead into gold. The Sirens may call on you to give up the mineral rights to your property because it is either popular, simple, or free to do so. It might be wiser to look for ear plugs?
  
• Cephinrectumus - This contorter tricks clinicians into "just say no" to EMR altogether. She deludes them into hoping this all goes away.... it won’t. She connives to keep doctors oblivious and in a dark, little world until it is too late. She is deceiving enough to be the most popular path chosen.
  

The good news... new trails are being mapped that bypass these monsters.
Alternative paths are necessary for any EMR product and implementation if a core value of the vendor is to "Do No Harm."

Also see - The Critically Sequential Path to Success and Alternatives to Doctors as Data Trolls?