How to convince doctors to embrace electronic medical records

Doctors are now incentivized to convert antiquated paper charts to electronic medical records.

Despite a few doctors who love their EMR, most readers here at KevinMD.com are skeptical, as the difficulties in transitioning, along with questionable benefits, have been well chronicled.

Recently, the Washington Post reported how the current incentives aren’t necessarily leading to a stampede towards electronic medical records.

Among the worries is that, “many doctors point out that they bear the biggest costs, while patients and insurance companies benefit most.” Indeed, when I wrote about the issue in USA Today a few years ago, “doctors receive only 11% of the savings from electronic records, with most of the savings going to health insurance companies and the government.”

Pediatrician Aaron Carroll notes some of the barriers the current health IT industry present to doctors:

Such systems are hard to use and difficult to maintain. They disrupt clinical practice. They don’t increase efficiency and often don’t pay for themselves. They disrupt the doctor-patient interaction. And they are very, very expensive …

… But it needs to be done. I fear that the current incentives – simple monetary carrots and sticks – that the government is trying in order to increase the use of information technology in the practice of medicine won’t work. Just as we have a patchwork insurance system in the US, we have a patchwork IT system as well. There are relatively few standards, tons of companies, and lots of failures. It costs too much, it doesn’t work as well as you’d think, and there are way too many avoidable errors.

Fragmentation is a problem.  Doctors don’t know who to trust, and many fail expensive IT conversions as they realize that demos by slick salespeople often don’t replicate real-life clinical practice.

Overseas, the NHS has taken the opposite approach, by implementing an electronic system from the top-down.  There have been growing pains there as well.  But, in the end, the result would be a unified, universal health IT system akin to that of the VA Stateside.  Perhaps there’s value in that approach.

The bottom line is that converting to electronic medical records is difficult, no matter how it’s done.  Most health IT experts have little clinical expertise, and forcing doctors to use systems built by computer engineers is a recipe for disaster.

The only way to get more doctors to use an electronic record system is to include physician input — from actively practicing providers — every single step of the way.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

email

Comments are moderated before they are published. Please read the comment policy.

  • http://www.HealthScepter.com David Yanga, M.D.

    I find the government incentive structure in the EHR world fascinating from an economic perspective. Did the government have to pay me to use Google, Twitter, my laptop or my smart phone? Physicians rapidly adopt technology that works well, simplifies life, and provides a meaningful function. The fact the the government has to subsidize EHR’s tells you that the current technology does not work very well for most physicians. When the technology matures, improves in functionality, and is priced correctly, adoption rates will rise accordingly. As you concluded, physicians input needs to be incorporated for functionality to improve.

    • jsmith

      Bingo. You got it.

    • ninguem

      Hey Dave, can I quote you on that? I’ve not heard it put better than the way you did. Spot-on.

      I’ll send the commission to your agent.

      • http://www.HealthScepter.com David Yanga, M.D.

        Thanks for your kind words. If you can use the comment to help others, then please do.

    • Primary Care Internist

      or we can just be dismissed as “technophobes” by self-appointed health management experts (often former nurses)

    • horseshrink

      Exactamundo!

      I’ve been perseverating the same message.

  • pcp

    Nice post, Kevin.

    Isn’t the basic problem that we never clearly identified what specific problems in American health care we expected EMRs to fix, and how they would do that? It was always a vague, changing list of save money/empower patients/increase billing/reduce staff/etc., all of which are proving to be pipedreams. Now, the main justification is data collection, and we have no idea if that is any more likely to materialize.

    In addition, in this country we’re terribly handicapped by having to build EMRs that work with the CPT/coding for dollars mess.

  • Jack

    It’s really not that difficult.

    Make a universal EMR for ALL practitioners AND payers (insurance/medicare). If you want to get paid, you need to use EMR. Give the EMR software for FREE.

    This will accomplish universal adaptation, information access and streamline billing.

    I am over simplifying but one get the idea.

    • Vox Rusticus

      Not good enough. Making an EHR work in my field involves multiple costly device integrations that allow transfer of data into the electronic record; at several thousands of dollars per device. And the software has to run on something, that something is usually a network, one that has to handle more traffic than a network not being used to keep an electronic medical record. Giving away “free” software isn’t enough, especially when I have to suffer the inconveniences of transition (done it before.) Making it a pre-condition to being paid for one’s work is a terrible idea, no matter who pays. That is nothing but extortion.

      • Primary Care Internist

        there is already a planned penalty for failure to adopt e-prescribing by a certain date (?2013 maybe?) so i don’t see the difference.

        i have been suggesting what Jack has said for years. One clear winner to me would be the VA Vista system. Not that it’s perfect, but many many many docs have trained in VA facilities during residency or fellowship, thus a significant portion are already familiar with it. And it’s already available and had years of tweaking.

        And i think since the winner, in terms of savings from efficiencies of not overtesting etc., will be medicare, and as taxpayers and docs we all want medicare to remain solvent, it makes sense to me that medicare should pay for it, and require it’s use for any entity billing medicare.

        As far as hardware costs, maybe medicare can give some flat payment for each physician who uses it ($5000 every couple of years?). If you’re thinking “that’s crazy, why would they do that????” then remember all the incentive money they’re talking about, potentially much much more.

        Of course, none of this will ever happen, because greedy companies like allscripts will give lobbying money to meet with and align with e.g. Obama so they can get a disproportionate share of “incentive” money and screw doctors and patients alike.

      • Jack

        There will never be a perfect system for every practitioner. I’ve gone to change in EMRs. It’s painful and expensive.

        I agree with Primary Care Internist. Government can offer some sort of credit to provider. But it doesn’t have to bear the cost of everything you want to customize.

        The idea of EMR is so patient information is accessible to all practitioners. That should be the MAIN goal. If information is available, we can provide better care. In theory that may cut cost.

        Mandating same EMR for all parties (including insurance/medicare) streamlines billing and payment. This will cut down on overhead.

  • jsmith

    The double-think here is mind-blowing. Dr. Carroll says, in essence, that most EHRs, as currently designed and implemented, are garbage. That is true. Then he goes on to say that implementation must be done. This is nuts.
    No, it does not need to be done. What needs to be done is that doctors need to follow the data in this area as they follow it in other domains and should refuse to be steamrolled by business types lusting for profit, ignorant bureaucrat, and irrational technophiles within the medical profession. Just say no to bad IT systems.
    I do not rule out the possibility that some day we will have cost-effective, clinically appropriate EHRs available in this country. When we do, sign me up. But the idea that we should inappropriately adopt the lousy current technology is stupid and, frankly, cowardly.

  • http://onhealthtech.blogspot.com/ Margalit Gur-Arie

    I somehow think there is another hidden problem here. If you look at computerized practice management systems (scheduling, billing), you will find that almost all physicians have those equally lousy systems in their office. In addition, practices that have in-house lab equipment are using LIS and smaller computerized lab systems. So what’s the difference?

    The difference is that EHR is requiring/mandating/forcing physicians to use the software for data entry. And data entry is a pain, no matter what software you use. Low paid resources don’t have much choice and they adapt to the point that veteran billers refuse to dump their DOS based antiquated billing system (Stockholm syndrome).
    Physicians are not very likely to do so voluntarily in large numbers. When they are employed by large systems and “resistance is futile”, they somehow manage to eventually “like” their systems too(I’m sure after much pain and suffering). Until we resolve/obviate/delegate/circumvent the need for physicians to enter massive amounts of data into the system (and this is getting worse now), we will not see significant improvement.

    • horseshrink

      Live in a warm pile of manure long enough and it becomes the new normal.

      Never mind that things are usually better outside the manure pile.

      We have a powerful capacity to habituate to almost anything. As you point out, that’s different from accepting something because it’s good.

  • http://hightechsurgeon.blogspot.com JF Sucher, MD FACS

    This is so easy to answer. Make software that actually helps the physician.

    @jsmith. Big problem is that it is clear that it doesn’t matter if physicians “Just say no to bad IT systems”. We have long lost the battle of being in control of our domain. What really needs to happen is that hospital systems and healthcare administrators need to say no to these bad systems. Follow the money… and you will find that the administrators are spending this money because they need to check the boxes necessary to satisfy CMS, or Joint Commissions certification or some other such nonsense… all under the guise of patient safety.

  • Smart Doc

    “The only way to get more doctors to use an electronic record system is to include physician input — from actively practicing providers — every single step of the way.”

    The money quote. Quite true.

    But this would be the very, very last thing on earth that the Federal Bureaucracy would ever do.

  • Lee Hauser

    How is “something that benefits the patient” a bad thing?

  • Tom

    Benefit to the patient is a nebulous concept, and is poorly defined. In terms of harm to the patient, EMRs have been linked to increased rates. If you can provide a concrete way in which it benefits patients, we’re listening. However, should it not benefit doctors as well?

    • Jack

      I can pull up medical record from anywhere I get internet access. Extremely helpful when I am covering call for my partner’s patients.

  • Lee Hauser

    Of course doctors should benefit as well. My comment was based on the perception that the benefits that accrue to patients are a negative aspect of EMR adoption. The situation for doctors will never improve if they don’t take (by force, if necessary) an active role in the inevitable transition.

  • ErnieG

    The problem with EMR for clinical physicians at the point of care is data entry and data retreivel in a manner that is easy, intuitive, non-obstructive, and conducive to patient care. The idea of everyone using the same EMR is a bad one- the VA EMR is no better tackling this issue.

    • Jack

      You got me there?! How is same EMR for all practitioners a bad one especially when it provide real time patient information for us?

      EMR isn’t perfect. Data entry and retrieval can be tedious. But what are you doing now? Pen and paper? Doctors are notorious for poor penmanship. How many lawsuits are results of illegible note or mistakes? How easy is it to track down a piece of lab result in the pile of “patient chart” or find that you documented you called the patient with critical results? Writing is a form of data entry! For us and past generation typing requires effort. For current generation and future ones, typing is second nature (just look at phone texting).

      VA EMR may not be the perfect solution but a UNIVERSAL EMR is a good start.

      • pcp

        During the past year, we’ve switched to voice recognition software for our paper charts. Once you’ve “trained your Dragon,” it is actually faster than standard dictation, is just as accurrate, and the notes get in the charts much quicker. And, for a three doc practice, it is a very real $45,000/year reduction in overhead: money straight into our pockets.Switching to an EMR and typing would be a tremendous step backwards for us.

        • horseshrink

          Problem for me is that I cannot generate Dragon dictated notes during patient encounters.

          With a paper chart & pen, I could. Appointment over? Note done.

          Next.

          Right now, the only ways to accomplish this:
          * Be an excellent typist (which should NOT be a prerequisite for medical school)
          * Hire a scribe. Expensive. (I thought EHR technologies were supposed to save money?)

          • pcp

            We’ve always dictated our fairly lengthy notes after the OV, so that’s not an issue for us.

            The take-home message is that this is a technology that gave us immediate savings in time and money, and didn’t require a $44,000 federal subsidy for us to invest in it.

          • horseshrink

            In my present institutional job I use Dragon 11 daily. Not bad. Quirky still because I don’t have the clearest diction. Would still prefer semi-templated paper/pen notes for outpt. visits.

            I agree with you. Some technologies are more mature than others. Some are ready for prime time. Voice recognition is largely in that ball park. EHR technologies on the whole, however, aren’t.

          • John Ryan

            I have used Dragon Dictate for years, way before I used an EMR. When Dragon version 10 was introduced, Nuance made a conscious decision to disable dictating into an EMR with all their products except the over $1,000 Dragon Medical version. Gives you some insight how the IT companies plan to squeeze us, once we install their pricey EMRs.

  • Joe

    I agree with primary care internist here. If EMR is the future why not use one system for all. How can this not make sense? Most docs trained in the last decade have used the VA system. Frankly I have found it betterthan the 6-7 since trainig. The latest system by Epic (one of the EMR big boys) is frankly a piece of crap. It is at least two generations behind the VA. You have to know all the little codes to get things done. It reminds me of a late 80′s version of wordperfect. Add on that the training is pathetic and the back up nil. It is a set up for disaster. Honestly these systems add 5 plus minutes per patient. In the present form most of these systems do NOT benefit the patient. They DO benefit the software vendors who have been very generous with contributions to legislators. It’ s all politics.

    • pcp

      I haven’t used the VA system. Is it based on CPT coding for dollars?

      • Zenfire

        Yes. It has CPT.

        And I agree, it’s much better than Epic.

  • horseshrink

    Agree with standards, though I don’t think they need to be in the form of a universal EHR. Rather, an approach similar to WWW data standards is likely to be most useful.

    Example:
    If I want to try a new browser (Firefox, Safari, Lynx, Konqueror, Chrome, Opera, IE, Galeon, …), the internet does not need to reconfigure its data structure. There is sufficient standardization of data structures to allow me to change browsers at will.

    I think the same should apply to health care information. Standardize the data constructs such that clinicians can then change EHR products at will.

    Currently, you buy an EHR product and you marry a proprietary database, for better and for worse. And, divorce is too expensive.

    Want to change products? Too bad.

    New product expense + data migration expense = prohibitive expense.

    Data standards would lubricate the market, fueling greater competition. Vendors could no longer lock-in their clients. Clinicians could too easily change over to a competitor’s product.

    Quality would improve. Cost would fall.

  • IowaSoloFP

    I would encourage people to read the whole of Aaron Carroll’s article, which is pretty well done. I disagree with him a lot but thought this essay was very fair.

    On the EMR, the big problem is data entry. Doctors aren’t and shouldn’t be transcriptionists or clerks. The president of the bank doesn’t go and enter every transaction himself. In my office I am essentially the only employee generating income. Time entering information is time not making money, or time away from home and family. Maybe that sounds harsh to people who feel physicians should be motivated purely by altruism but that’s the way it is.

    I buy things for my office for two reasons – either to make money or make my life easier. EMR costs me money and makes my life harder. The Medicare incentives are inadequate, especially since based on past experience I will have to jump through a bunch of hoops and there’s still a good chance I won’t see the payments.

    I downloaded the VA Vista system and played with it on my computer. It seemed as much or more unwieldy than any other EMR and the only benefit I see is that it is widespread. The VA notes I’ve received on nursing home transfers are mostly an unintelligible mess designed to keep the patient’s diagnoses hidden from all.

    What the pundits and politicians are missing is for an EMR to be adopted it first has to be GOOD. For the small office the EMR hasn’t yet achieved that goal. For a large group I can see the benefits.

    • horseshrink

      Absolutely.

      I hear the non-clinician side tout training, training, training! Docs are whining! Suck it up! Get with the program! This is the future! We need to “all work together.” Fix the doctor with training, training, training. Then their eyes will be opened and they will see the miracles before them on the screen! Hallelujah!

      As a life-time geek and daily EHR user, I’m still blind to these purported miracles. Guess I forgot to drink the Koolaid.

      The problem is NOT the doctor!!!!!!

      It’s the PRODUCT!!!!

      My annoyed comment to the EHR non-clinicians out there: Give us what WE want! (not what YOU want) … Give us something that’s good enough that we can’t see ourselves NOT using it … something that makes us “ooooo” and “Ahhhh!” Something that makes us faster, smarter, safer and more profitable. And we will STAND in LINE to buy it!!!

      But, the industry and technology isn’t there yet. It’s too immature for the current hype.

      To catalyze the maturation, market forces need lubrication (described in a post above.)

  • Lee Hauser

    What’s going to happen when your patients start abandoning you because you can’t provide them with electronic access to their health records? When your competing practices are all electronic and can exchange data with local hospitals and you can’t? I talked to a friend last night who is abandoning his current healthcare provider (who does have an EMR system) for one who is able to give him electronic access to his health records, test results, etc. Patients are becoming more sophisticated and may come to expect more of you than paper records systems can provide.

    • horseshrink

      Not a major variable. Patients largely choose docs based on conformity to their insurance plan and reputation.

      If you have an excellent doctor, are you going to ditch him because you can’t log on to an office website for your records? I wouldn’t. And I’m a definite geek.

      • Phoenix

        I would disagree that statement. I recently moved my family from a good practice and doctor to another based on the fact my former dormer doctor did not use an EMR system.
        Why? My medical records and those of my family aren’t going to us any good if they are sitting in some file cabinet where all the other paper records are stored. However if my primary practioner records are stored in an EMR system that’s shared with the local hospital then it’s all there available in case of emergency.

        Of course I’m one of those “technophiles” I’ve heard other commentors deriding. I’m sorry but the days of paper records and mostly the independent practioner is over. Medical groups which are part of a large IDN, for better or for worse are the future.

        • IowaSoloFP

          Well, when I finished residency over 20 years ago I was told solo docs were dinosaurs and we all were going to have to join HMOs. Eventually I guess you’ll be right and I’ll be gone or an employee.

          I do think you’re missing the point though. I have generally been a technophile and an early adopter myself and would like to have an EMR that is efficient and easy to use. So far I haven’t found one. The government push to adopt the technology is ahead of the technology itself. And right now most of the software is proprietary, so for the most data can’t be shared if you were to move or go to a hospital outside your current system.

        • horseshrink

          I’m no Luddite. Most docs aren’t.

          Your new doc might be one of those rare docs who takes your insurance, can see the same number of patients per day while typing into an EHR, all the while preserving a personable “bedside manner” from the keyboard, wielding solid clinical skills. If so, don’t change docs!

          For docs who aren’t typists, scribes are being used … a significant overhead expense (that purportedly pays for itself through improved productivity) and a new “third person” in the examination room.

          My point is that EHR technologies in their current evolutionary phase are no panacea for the docs who must actually use them throughout every work day.

          I also believe there is a simpler, cheaper, less intrusive and more effective way to fire EHR technologies evolution … development/maintenance of data standards so that EHR products can be changed “at will” by clinicians. This would heat up competitive development in the EHR market.

          When EHR companies make something docs actually want, they will willingly open their wallets, without federal mandates.

          • John Ryan

            Sometimes I have to laugh at some of the posts here. Talk about an early adopter — someone actually changed doctors to get one with an EMR? You should have looked at some of the notes from EMRs. After the canned (but clearly typed) prose required for Medicare E/M, CPT & ICD codes & insurance billing, it’s hard to find a real medical fact or impression. Not to mention that they don’t even electronically communicate with each other, we still have to send notes by fax! Find a doctor who looks at you and not his laptop in the exam room.

  • Lee Hauser

    @Horseshrink, I’m sure you’re right. Perhaps more physicians need to be involved with the creation of EMR systems, as Jon Bertman did when he created Amazing Charts. I see stories all over the place of physicians being involved with the creation of the software they wanted to use — the intensivists in Baltimore that created the VISICU tele-ICU system, the group of D.C. physicians and researchers that created what is now Microsoft’s Amalga. It’s certainly not something every doctor should want or need to do, but a lot of great software was created based on the passion and need of one or a few individuals.

    Software manufacturers need to actually get involved with, and learn from, the medical community…because it sure appears that they haven’t up to this point.

  • Deserat

    @horseshrink is correct – I’m shocked at what I see as amenable for EHRs – the screens are so full of crap – the clinician barely looks at the patient – they are hunting around for the drop down code they want – most still don’t interact well with any simple medical devices in the MD office.

    The comment about data standards is spot on. If the data is uniformly coded then you can wrap any application mechanism around it – they just need to have the data standard code engine between. Unfortunately, the vendors would then have to truly compete on the human interface – the ooos and ahhhs – and not on the fact that they’ve vertically tied up the whole data stream so it works in their constricted environment.

  • http://www.healthcaremarketingcoe.com Simon Sikorski, M.D.

    Common problem I see in almost all cases of EMR adoption… lack of customer support. Once a doctor buys EMR system do companies care about the actual adoption?

    No. What I see day in day out is sales people get to the doctors’ office, spend several days training the office staff on proper use … but then abandon them over the next few weeks or months, instead of reinforcing the newly acquired knowledge.

    Customer service is key.

  • Lee Hauser

    I know nothing from experience on this, but perhaps that kind of expectation (which is, to my mind, perfectly reasonable) could be written into the contract.

    Vendors, of course, are not always enthusiastic about this kind of ongoing support, which is why, in former lives, I’ve generally worked with value-added resellers of complex products. They know the software inside and out, sell it, train on it, and continue to support it after the sale, acting as first-tier support with a direct line to the manufacturer’s tech support department. The time is ripe for these kinds of relationships to sprout in the medical world, if they don’t exist already.

  • horseshrink

    Suggest folks above also comment here on the ONC site re: their recently published strategic plan:
    http://www.healthit.gov/buzz-blog/from-the-onc-desk/hit-strat-plan/

  • Jai

    As a computer scientist and now studying pre-med, I’d like to present another side of the picture that has been mentioned above but not hardly with the same degree that other views have been mentioned.

    EMR/EHR whatever you would like to call them are a move towards streamlining some of the processes, overhead, and duplication of efforts in medicine. That said, I’ve heard lots of comments and cries about how systems do not work appropriately, or do not meet physician needs, do not improve patient care, etc. etc. And at the very end of all of these arguments is that idea that the technology is not there. I must loudly disagree. In an era where we put 5 megapixel camera’s in phones, conduct online learning around the globe, tweet, facebook, conduct multi-continent projects, and have teams that work in completely virtual environments, the argument that the technology is not there is not only untrue but at this point just plain ridiculous. By all accounts the technology is not only present but rapidly evolving. And while it may not look, feel, or present in a manner that is efficient for physicians, that it ultimately a problem for physicians to deal with, one that is going to require working with the software industry. Additionally, it may help to understand up front that moving to EHR is going to require changes in how jobs are done on a daily basis, adjustments in how we interact with patients, etc. Will the change be seamless and without some problems and inefficiencies at first? No, but what change ever has?

    LIke it or not, it is the healthcare industry that is being forced to change, not the software industry. The software industry will financially benefit from EHR systems whether physicians like them or hate them. Because again like it or not, its the healthcare industry that is being forced to change. And since we live in an ever increasingly technological world I would venture to guess that future patients are going to insist doctors be able to keep up with tech. Very soon, gone will be the days where a patient leaves one doctor and before they can go to another has to have entire files/image studies placed on disk ( or worse yet copied and placed in a file) in order to have all the medical records available to the next physician. There is an entire generation that has grown up and is growing up in which computers and advance technology has always been readily available. Use of technology is important to them and will be important to them when they choose a physician. Want an example of how rapidly technology can change both patron perception of your business and also the way we communicate and interact, take a look at the telecommunications, journalism, and travel industries.

    So I say all that to say, if the EHR products do not allow you to work efficiently, then I would suggest you begin to send suggestions on how they can be improved, and actively begin to get involved with the requirements gathering and design process of these systems. If a standard protocol for systems would make them better then I would suggest physicians band together and scream loudly for this to take place. If a nationalized EHR system would be best, then again I would say band together and demand that. EHR’s are a part of the healthcare industry future, the only question is how difficult everyone wants the change to be. Mom always said those who don’t have a plan will have one chosen for them.

    • http://zenfire.tumblr.com Zenfire

      You’re missing the point.

      Yes, tech is great. Yes, it’s great in many aspects of modern life. What most of us are saying is that the same quality we see in other industries is not being offered to us in the healthcare industry. Have you even used an EMR before? Myself and a good portion of my residency class actually did have a CS background. We aren’t luddites and we do know what we’re talking about. Basic principles of design and work flow that are standard in every other area of program design are completely overlooked when it comes to EMR programs. Come spend some time with the crap we’re offered and I think you’ll quickly see what we’re talking about.

      We desperately want something decent so we can benefit from modern technology the way other industries have and the way we have when it comes to things like labs, imaging, procedures and other tools. We aren’t anti-tech. Clearly we use a lot of it. We just have found the programs to be severely lacking.

      If what was offered was good, you wouldn’t have to convince us to use it, we’d already be doing so. What we have now actually hurts healthcare.

      • horseshrink

        Nicely said.

      • jai

        I don’t believe I’m missing the point at all. I completely understand that the packaged product is not worthwhile for most. But, the technology itself does exist to produce a worthwhile product. And yes, I have seen EMR used and can honestly say its worked well for some, poor for others. So I completely understand why physicans are complaining overall. However, I also understand that resistantance or negatvitiy towards the software and technology is not going to solve the problem. Particularly, when we seem to be at a time that government and the public are practically demanding that a change take place. And not only take place, but sooner than later. Which is why I recommend that physicians come together to help in the process. As someone nicely wrote ” The geeks who write most of the EMRs (based on the types they send out to sell it to me) are at home in their chairs in front of 2 monitors.” … Correct, the people who write EMR are developers, most of whom have no concept of meaningful patient interaction or healthcare workflow. However, they get paid to create a system. And without someone giving clear, consice understanding and requirements of how the system should look, feel, and function for best use in the real world, physicians will keep getting “crap” that they don’t want and that makes them inefficient. And, eventually physicians are going to be forced to make the change to something they don’t want and something that doesn’t work.

        I’ve seen business’ move to systems that were ill-thought out and not equipped to work well with their business model. And in almost all cases the new, inefficient system is not just thrown out and everyone starts over. No, what happens is everyone is angry, workaround processes are put in place to subvert and game the system, and then everyone comes to the table to figure out how to best tweak or enhance the system so it will be effective. BUT, all the while the end-users are the people being impacted. I’m suggesting that physicians and the healthcare industry as a whole avoid the same pitfalls that so many other industries have fallen into when its come to technology changes. Instead of resistancing, or just screaming about how it doesn’t work well, come together and work with the software industry to create, at minimum, a good skelton of how you would like a system to look and function. Do I think technology should be forcefully pushed on people/industries? No. But, at the same time I’m not naive so I know it happens. Just as I know that consumers and politicians tend to push for changes in technology and policy that they don’t truly understand the practice of or ramifications.

        Re: “The decision re: whether a technology is ready for use by medicine does NOT belong to computer scientists, or administrators, or bureaucrats. As you will eventually find, once you are wearing the shoes you once designed, that decision belongs to the end-user.” … Its been my experience that while such decisions SHOULD belong to the end-users, they rarely do. Instead, its usually bureaucrats, administrators, and soceital demands determining change. End-users get the burden of figuring out how to conform to such changes. It’s also been my experience that end-users who are not active participants in the process and those who don’t come to the table with ideas/solutions, usually get their decisions made by others and usually to the detriment of the end-user and the persons they are trying to support.

        ” It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.” ~Charles Darwin

        “Things alter for the worse spontaneously, if they be not altered for the better designedly.” ~Francis Bacon

        • horseshrink

          @jai: Re: “It’s been my experience that while such decisions SHOULD belong to the end-users, they rarely do. Instead, it’s usually bureaucrats, administrators, and societal demands determining change.”

          The physician, as end-user is usually still the decision maker re: EHR technologies. For instance, around 60% of docs still practice independently. http://www.nejm.org/doi/full/10.1056/NEJMp0808076

          If the EHR industry wants a durable presence in such physician run offices, where adoption has been slowest, it must actually give them what they want, or they won’t write the check.

          From the 2008 CBO report:
          http://www.cbo.gov/ftpdocs/91xx/doc9168/05-20-HealthIT.pdf
          “For providers and hospitals that are not part of integrated systems, however, the benefits of health IT are not as easy to capture, and perhaps not coincidentally, those physicians and facilities have adopted EHRs at a much slower rate. Office-based physicians in particular may see no benefit if they purchase such a product—and may even suffer financial harm. Even though the use of health IT could generate cost savings for the health system at large that might offset the EHR’s cost, many physicians might not be able to reduce their office expenses or increase their revenue sufficiently to pay for it.”

          Adam Smith’s “invisible hand” is nimbler and more powerful than a bureaucrat, administrator, or politician.

          No federal mandate compelled us to use endoscopes, PET scanners, MRI, stents, IMRT, genotyping, microsurgical equipment … We use what works, clinically and financially, despite steep, associated learning curves or start up expenses.

          And the learning curve for EHR technologies is gentler than that encountered for much of the technology we use. So why haven’t we been buying?

          EHRs are still at the “Apple Newton” phase. We just don’t see the point of buying that technology yet. When it’s “iPad” mature, we will.

    • horseshrink

      Please rest assured that physicians are not Luddites. If so, we’d still be using plain films of skulls … or just palpating and auscultating them. If anything, nowadays, we might rely on technology to the detriment of our relationships with patients.

      I agree heartily that there is mind-blowing technology out there. In reading The Economist recently, I was dumbfounded to find how ignorant I was re: 3D printing … and how far along it is. I agree that the technology is definitely out there now to make really, really useful EHR systems. I’ll be glad when they finally evolve into existence.

      Re: banding together and asserting ourselves … The most powerful place this can be realized is a well oiled marketplace. Look at the effect the market has had on technology in general! If people find technologies to be useful … they buy. If not … they don’t. Apple’s Newton wasn’t good enough. Eventually the iPad wowed.

      I really don’t think our main resistance is to technology.
      I think our resistance is to technology designed poorly by non-clinicians being forced down our throats by non-clinicians.

      And the non-clinicians seem surprised and indignant that we could dare to be so resistant, holding our reactions forth as prima facie evidence that we are merely bumbling, ignorant, stubborn Luddites that must be herded dumbly to enlightenment.

      Technology is but a tool. Medicine adapts to technology to the extent that it furthers the aims of medicine. It is more important that technology adapt to the raison d’être of medicine than vice versa.

      The decision re: whether a technology is ready for use by medicine does NOT belong to computer scientists, or administrators, or bureaucrats. As you will eventually find, once you are wearing the shoes you once designed, that decision belongs to the end-user.

      • John Ryan

        I’m not surprised that the technophiles don’t get it. Many of my patients spend more time on Facebook than talking to their families. The geeks who write most of the EMRs (based on the types they send out to sell it to me) are at home in their chairs in front of 2 monitors. I work in a different world. I have to talk to & figure what’s wrong with 25+ humans a day, face to face, and I don’t need crap-ware to do it. If you can write something that duplicates my workflow, you are welcome. Otherwise, go back to writing a better Farmville.

        • horseshrink

          I like this quote:

          “The real danger is not that computers will begin to think like men, but that men will begin to think like computers. ~Sydney J. Harris”

          http://www.quotegarden.com/computers.html

  • Lee Hauser

    I’ve been though the computerization of a non-computerized industry. When I started in law office IT in 1990, there were few computers and almost none of them were on attorney desks. They didn’t like having to learn something new. They saw using a keyboard as beneath them. They were dragged, kicking and screaming, into the computer age. They went because their peers were doing it — not just doing it, but making life difficult for them if they didn’t. They went because the government (in the form of the court system) demanded it.

    The world is changing. Perhaps it’s time to get active, get vocal, get on the bandwagon and make a difference in how the systems are built and used. Or, maybe — just maybe — as an individual provider you can hold out until you retire, let all the unpleasantness pass you by.

  • http://www.plus91.in Aditya Patkar

    Two articles here, one on Improving Patient Care and Increase Profits due to EMR can help convince Doctors about the benefits of EMR:
    http://technology4doctors.blogspot.com

  • PAULMD

    Another name for the article could have been, “….or how I learned to stop worrying and love the bomb”

Most Popular