There is a project that has been around for almost 3 years now from CodePlex, the open source arm of Microsoft that is called the Common User Interface, in other words the screens and front end of the program that we use. Is that not a grand idea to have all system similar/same and all vendors could still maintain their working functions at the back end and other departments? Some developers have worked with it as well as the NHS and it’s dynamic and uses Silverlight, lots of dragging and dropping to keep the “click wars” down to a minimum as well as integrate PACS imaging too, pretty intuitive. I remember working with my beta office all about working around to keep the clicking down to a minimum, a valid issue by all means and did my best. Even back in the early days, you didn’t have to make everything gray either, I used images and screens that were user friendly, but most do not, but you can have both if you work at it.

I chat with an MD/Developer in New Zealand and he did some work with it and I have a post that shows a bit how he developed it.

http://ducknetweb.blogspot.com/2008/10/common-user-interface-ehr-development.html

Back in 2008 I saw this getting very complicated and look where we are today. Sometimes competition creates some of this too. The post below has a video about how the interface would work.

http://ducknetweb.blogspot.com/2008/10/ehr-adoption-remains-off-in-distance.html

I agree with some of the comments above here too though that Epic (system at Kaiser) is about the best out there, they put a lot of work into it for sure. I interviewed a doctor from Long Beach Memorial on their transition and he states that they were very open for suggestions and idea and even contributed back to Epic on ideas they could use too, so a good EMR is a 2 way street for sure.

http://ducknetweb.blogspot.com/2009/04/long-beach-memorial-centers-conversion.html

Technology is giving everyone fits too as just as soon as we digest one solution there’s 10 more knocking at the door too, and that challenges everyone, so I completely understand the argument of just wanting a system that works and helps you get your record keeping done and I think more collaboration, not competition here will be a real key to get us there.

The problem isn’t market size. It’s that legacy vendors are looking through the wrong end of the telescope. They are providing bloated systems laden with features and screens that they as developers like, not what docs want and need. The result is outrageously expensive systems that don’t meet the needs of their potential customers. That’s why, to date, fewer than 30% of hospitals and 15% of physician practices have bought what they have been selling.

Changing a provider’s software to be patient-centric and not provider-centric is a huge task. Plus, don’t forget healthcare generates ENORMOUS amounts of data compared to other industries.

1. The current status of the health care marketplace and how medical services are paid for is the biggest reason for EHR systems being immature.
2. A medical student is not mature enough in their understanding of the dynamics of the health care to be a valid opinion.
3. The complexity of health care data is far greater than any other industry I have been involved in and may be more complex than any other IT area.
3. The argument that the market is too small is completely invalid. The example of there only be 7500 hospitals breaks down because the cost of EHR systems runs from about $5M – $50M depending on the size of the hospital. Assuming the average is $10M that makes the market for hospital-based EHR systems about $75B. Whereas a video game only costs about $50. So even if you sell your game to 5% of all Americans you would only make $625M. And that does not include the number of EHR systems you might sell to physician offices which number approximately 500,000 in the US alone. EHRs for physician offices only cost about $50K-75K but you get the point. The market is NOT small.

So why are EHR systems so far behind? The answer really is that the payment system is messed up. Vendors go to where the money is because they need to make money to be profitable. The payment system has always paid doctors and hospitals for what they do (services they perform). They are not paid to share information with other providers, as a matter of fact they are disincentivized to share data. When they perform another test they get paid, when they use one from another doctor they are not.

Secondly departments within a hospital (such as radiology and laboratory) have never had an reason or incentive to share data. Each purchased its own system and implemented it for its own reasons. Sharing data cost more, and you got paid less! Oops.

Specialty systems are complex. Designing a system for medical images is a big deal. Designing the database of this system so it would allow you to share the data was often an afterthought because hospitals did not want to pay extra for something that would cost them money.

Think of an EHR as a big database with a user interface of all the data generated by all other systems which are effectively incompatible with one another. Going to your gaming analogy this would be like creating a new “game” that would be a combination of an XBox, Wii and PlayStation games that would look and work well. The three gaming vendors would have no incentive to do this nor the standards to combine these together. The designer would have to use the lowest common standards or perhaps create some custom code to make this work. This is somewhat similar to what EHRs are up against except that the data is very complex, critical to peoples health and has strong privacy and security requirements.

So while I am also not yet excited by the current state of EHRs I tend to give the EHR vendors a break.

Also, where are a patient’s records for care received before they joined KP or for out-of-network care while a member of KP? Aren’t they relevant to treating the patient?