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EMR Issues That Generate Med Mal Payouts Sound Familiar

Posted on February 8, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

When any new technology is adopted, new risks arise, and EMR systems are no exception to that rule. In fact, if one medical malpractice insurer’s experience is any indication, EMR-related medical errors may be rising over time — or at least, healthcare organizations are becoming more aware of the role that EMRs are playing in some medical errors. The resulting data seems to suggest that many EMR risks haven’t changed for more than a decade.

In a recent blog item, med mal insurer The Doctors Company notes that EMR-related factors contributed to just under one percent of all claims closed between January 2007 through June 2014. Researchers there found that user factors contributed to 64% of the 97 closed claims, and system factors 42%.

The insurer also got specific as to what kind of system and user factors had a negative impact on care, and how often.

EMR System Factors: 

  • Failure of system design – 10%
  • Electronic systems/technology failure – 9%
  • Lack of EMR alert/alarm/decision support – 7%
  • System failure–electronic data routing – 6%
  • Insufficient scope/area for documentation – 4%
  • Fragmented EMR – 3%

EMR User Factors

  • Incorrect information in the EMR – 16%
  • Hybrid health records/EMR conversion – 15%
  • Prepopulating/copy and paste – 13%
  • EMR training/education – 7%
  • EMR user error (other than data entry) – 7%
  • EMR alert issues/fatigue – 3%
  • EMR/CPOE workarounds -1%

This is hardly a road map to changes needed in EMR user practices and system design, as a 97-case sample size is small. That being said, it’s intriguing — and to my mind a bit scary — to note 16% of claims resulted at least in part due to the EMR containing incorrect information. True, paper records weren’t perfect either, but there’s considerably more vectors for infecting EMR data with false or garbled data.

It’s also worth digging into what was behind the 10% of claims impacted by failure of EMR design. Finding out what went wrong in these cases would be instructive, to be sure, even if some the flaws have probably been found and fixed. (After all, some of these claims were closed more than 15 years ago.)

But I’m leaving what I consider to be the juiciest data for last. Just what problems were created by EMR user and systems failures? Here’s the top candidates:

Top Allegations in EMR Claims

  • Diagnosis-related (failure, delay, wrong) – 27%
  • Medication-related – 19%
    • Ordering wrong medication – 7%
    • Ordering wrong dose – 5%
    • Improper medication management – 7%

As medical director David Troxel, MD notes in his blog piece, most of the benefits of EMRs continue to come with the same old risks. Tradeoffs include:

Improved documentation vs. complexity: EMRs improve documentation and legibility of data, but the complexity created by features like point-and-click lists, autopopulation of data from templates and canned text can make it easier to overlook important clinical information.

Medication accuracy vs. alarm fatigue: While EMRs can make med reconciliation and management easier, and warn of errors, frequent alerts can lead to “alarm fatigue” which cause clinicians to disable them.

Easier data entry vs. creation of errors:  While templates with drop-down menus can make data entry simpler, they can also introduce serious, hard-to-catch errors when linked to other automated features of the EMR.

Unfortunately, there’s no simple way to address these issues, or we wouldn’t still be talking about them many years after they first became identified. My guess is that it will take a next-gen EMR with new data collection, integration and presentation layers to move past these issues. (Expect to see any candidates at #HIMSS16?)

In the mean time, I found it very interesting to hear how EMRs are contributing to medical errors. Let’s hope that within the next year or two, we’ll at least be talking about a new, improved set of less-lethal threats!

Fear of Saying Yes to Healthcare IT

Posted on February 5, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve seen a theme this week in healthcare. The theme keeps coming up and so I thought I’d highlight it here for others to comment on. The following Twitter exchange illustrates the discussion:


This reply is about secure text, but “this” in Nick’s tweet could be a wide variety of tech solutions. So, fill in “this” with your favorite health IT solution.

Andrew Richards responded:

And then I replied:


Andrew is right that there are a lot of solutions out there, but the “gatekeepers” as he calls them are saying no. My tweet was limited to 140 characters, so I highlighted the fear element assciated with not saying yes. However, that definitely simplifies the reason they’re not saying yes. Let’s also be clear that they’re not usually saying no either. They’re just not saying yes (this is is sometimes called misery by sales people).

While I think fear is a major element why the health IT gatekeepers are saying no, there are other reasons. For example, many are so overwhelmed with “bigger” projects that they just don’t have the time to say yes to one more project. Even a project that has great potential to provide value to their organization. I’ve heard some people argue that this is just an excuse. In some cases that may be the case, but in others people really are busy with tons of projects.

Another obstacle I see is that many feel like they’ve been burned by past health IT projects. The front runner for burning people out is EHR. No doubt some really awful EHR implementations have left a black eye on any future healthcare IT projects. If you’d been through some of the awful EHR implementations that were done, you might be afraid of implementing more IT as well.

Nick Adkins finished the Twitter exchange with this tweet:


Nick has spent some time at burning man as you can tell from his tweet. However, a passion for improving healthcare and going above and beyond what we’re doing today is a key strategy to saying yes to challenging, but promising projects.

I’d love to hear your thoughts on this subject. Are there other good reasons people should be afraid of implementing new technology? Do we need to overcome this fear? What’s going to help these health IT “gatekeepers” to start saying yes?

Practice Fusion Cuts 25% of Staff

Posted on February 4, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Following on our post a few weeks ago about the potential Practice Fusion IPO, news just came out that EHR vendor, Practice Fusion, has now cut its staff by 25%. The Techcrunch report says that the cuts were across the board and affected roughly 74 people. Many are suggesting that the two reports are related since cutting staff is a great way to improve your profit numbers before an anticipated IPO.

While I think the IPO could be in mind, I think there are likely some other trends at play too. While Techcrunch notes that it’s a down market for many IT companies, I think it’s fair to say that many EHR vendors have felt the pinch of late. I wrote a year or so ago that the golden era of government incentivized EHR sales was over and we’re entering a much different market. So, it shouldn’t be a surprise that an EHR vendor might go through some cuts as the false market created by meaningful use disappears. I won’t be surprised to see more layoffs from other EHR vendors. Especially ambulatory EHR vendors like Practice Fusion.

No doubt another factor at play is that Tom Langan replaced Ryan Howard as CEO back in August. It’s very common for a new CEO to go through a round of layoffs after taking over a business. Doing so is hard for the previous CEO who’s so connected to the staff. Not that layoffs are ever easy, but it’s much easier for a new CEO to layoff people in order to make the organization more efficient. That’s particularly true when the previous CEO was the original CEO and Founder of the company.

The cynical observer could also argue that Practice Fusion needed to do these layoffs in order to slow their burn rate since they aren’t in a position to raise more capital. You’d think the $150 million they already raised would give them plenty of run way. However, you’d be surprised how quickly that disappears with that many staff on payroll (Not to mention rents in San Francisco). I personally don’t think this is a case of Practice Fusion cutting staff because they can’t go and raise money. However, it could be Practice Fusion cutting its burn rate so that they have some flexibility on when they go public without having to raise more money.

All of this said, 74 people lost their jobs at an EHR vendor. That’s never fun for anyone involved. At least they’ll likely have plenty of job opportunities in silicon valley. Unless that bubble pops like some are suggesting. It will be interesting to see how many now former Practice Fusion employees search for another job in health care IT.

Patients Favor Tracking, Sharing Health Data

Posted on February 3, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

To date, I’d argue, clinicians have been divided as to how useful medical statistics are when they come straight from the patient. In fact, some physicians just don’t see the benefit of amateur readings. (For example, when I brought my own cardiologist three months of dutifully-logged blood pressure and pulse readings, she told me not to bother.)

Research suggests that my experience isn’t unique. One study, released mid-last year by market research firm MedPanel, found that only 15% of physicians were recommending wearables or health apps to patients as tools for growing healthier.

But a new study has found that patients side with health-tracking fans. According to a new study released by the Society for Participatory Medicine, 84% of respondents felt that sharing self-tracking stats such as blood glucose, blood pressure, heart rate and physical activity with their clinician would help them better manage their health. And 77% of respondents said that such stats were equally important to both themselves and their healthcare professional.

And growing numbers of healthcare professionals are getting on board. A separate study released last year by Research Now found that 86% of 500 medical professionals said mHealth apps gave them a clearer understanding of a patient’s medical condition, and 76% percent felt that apps were helping patients manage chronic illnesses.

Patients surveyed by the SPM, meanwhile, seemed downright enthusiastic about health trackers and mobile health:

* 76% of adults surveyed would use a clinically-accurate and easy-to-use personal monitoring device
* 57% of respondents would like to both use such a device and share the data generated with a professional
* 81% would be more likely to use a consumer health monitoring device if their healthcare professional recommended such a device

Realistically, medical pros aren’t likely to make robust use of patient-generated data unless that data can be integrated into a patient’s chart quickly and efficiently. Some brave clinicians may actually attempt to skim and mentally integrate data from a health app or wearable, but few have the time, others doubt the data’s accuracy and yet another subgroup simply finds the process too awkward to endure.

The bottom line, ultimately, seems to be that patient-generated data won’t find much favor until hospitals and medical practices roll out technologies like Apple’s HealthKit, which pull the data directly into an EMR and present it in a clinician-friendly manner. And some medical pros won’t even be satisfied with a good presentation; they’ll only take the data seriously if it was served up by an FDA-approved device.

Still, I personally love the idea of participatory medicine, and am happy to learn that health trackers and apps might help us get closer to this approach. As I see it, there’s no downside to having the patient and the clinician understand each other better.

#HIMSS16: Some Questions I Plan To Ask

Posted on February 1, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

As most readers know, health IT’s biggest annual event is just around the corner, and the interwebz are heating up with discussions about what #HIMSS16 will bring. The show, which will take place in Las Vegas from February 29 to March 4, offers a ludicrously rich opportunity to learn about new HIT developments — and to mingle with more than 40,000 of the industry’s best and brightest (You may want to check out the session Healthcare Scene is taking part in and the New Media Meetup).

While you can learn virtually anything healthcare IT related at HIMSS, it helps to have an idea of what you want to take away from the big event. In that spirit, I’d like to offer some questions that I plan to ask, as follows:

  • How do you plan to support the shift to value-based healthcare over the next 12 months? The move to value-based payment is inevitable now, be it via ACOs or Medicare incentive programs under the Medicare Access and CHIP Reauthorization Act. But succeeding with value-based payment is no easy task. And one of the biggest challenges is building a health IT infrastructure that supports data use to manage the cost of care. So how do health systems and practices plan to meet this technical challenge, and what vendor solutions are they considering? And how do key vendors — especially those providing widely-used EMRs — expect to help?
  • What factors are you considering when you upgrade your EMR? Signs increasingly suggest that this may be the year of the forklift upgrade for many hospitals and health systems. Those that have already invested in massiveware EMRs like Cerner and Epic may be set, but others are ripping out their existing systems (notably McKesson). While in previous years the obvious blue-chip choice was Epic, it seems that some health systems are going with other big-iron vendors based on factors like usability and lower long-term cost of ownership. So, given these trends, how are health systems’ HIT buying decisions shaping up this year, and why?
  • How much progress can we realistically expect to make with leveraging population health technology over the next 12 months? I’m sure that when I travel the exhibit hall at HIMSS16, vendor banners will be peppered with references to their population health tools. In the past, when I’ve asked concrete questions about how they could actually impact population health management, vendor reps got vague quickly. Health system leaders, for their part, generally admit that PHM is still more a goal than a concrete plan.  My question: Is there likely to be any measurable progress in leveraging population health tech this year? If so, what can be done, and how will it help?
  • How much impact will mobile health have on health organizations this year? Mobile health is at a fascinating moment in its evolution. Most health systems are experimenting with rolling out their own apps, and some are working to integrate those apps with their enterprise infrastructure. But to date, it seems that few (if any) mobile health efforts have made a real impact on key areas like management of chronic conditions, wellness promotion and clinical quality improvement. Will 2016 be the year mobile health begins to deliver large-scale, tangible health results? If so, what do vendors and health leaders see as the most promising mHealth models?

Of course, these questions reflect my interests and prejudices. What are some of the questions that you hope to answer when you go to Vegas?

Solution for “Too Many Clicks” Problem in EHR?

Posted on January 27, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve long been intrigued by the complaint I hear from doctors about “too many clicks” in the EHR. Long time readers may even remember my piano analogy which looks at the issue of too many mouseclicks and keystrokes in EHR software. I still think that largely applies today.

With that said, I’ve been fascinated to watch the evolution of click free solutions like what Note Swift is offering. Many are familiar with Dragon Naturally speaking an in particular the Dragon Medical product. It does amazing voice recognition. What I love about NoteSwift is that it takes Dragon’s voice recognition and integrates it naturally into the EHR interface.

Here’s a demo video that was all done by voice using NoteSwift to illustrate how it works:

I think it’s fascinating to see the evolution of these products. Plus, with things like Siri. “Ok Google”, and even Amazon Echo,we’re creating a culture of people who are use to using their voice to do things. So, that will help efforts like the one above.

No doubt doctors are blown away by the concept of documenting a patient visit with 1, 3, or 5 clicks. Now let me leave what’s available today and think into the future. Imagine a video EHR which was voice enabled. The doctor could literally go into the room and using video, voice recognition, NLP, technologies like NoteSwift, connected devices, etc they could easily chart a note with no clicks. While that’s not happening tomorrow, it’s not as far fetched as you might imagine.

Will New Group Steal Thunder From CommonWell Health Alliance?

Posted on January 26, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Back in March 0f 2013, six health IT vendors came together to announce the launch of the CommonWell Health Alliance. The group, which included Cerner, McKesson, Allscripts, athenahealth, Greenway Medical Technologies and RelayHealth, said they were forming the not-for-profit organization to foster national health data interoperability. (Being a cynical type, I immediately put it in a mental file tagged “The Group Epic Refused To Join,” but maybe that wasn’t fair since it looks like the other EHR vendors might have left Epic out on purpose.)

Looked at from some perspectives, the initiative has been a success. Over the past couple of years or so, CommonWell developed service specifications for interoperability and deployed a national network for health data sharing. The group has also attracted nearly three dozen HIT companies as members, with capabilities extending well beyond EMRs.

And according to recently-appointed executive director Jitin Asnaani, CommonWell is poised to have more than 5,000 provider sites using its services across the U.S. That will include more than 1,200 of Cerner’s provider sites. Also, Greenway Health and McKesson provider sites should be able to share health data with other CommonWell participants.

While all of this sounds promising, it’s not as though we’ve seen a great leap in interoperability for most providers. This is probably why new interoperability-focused initiatives have emerged. Just last week, five major HIT players announced that they would be the first to implement the Carequality Interoperability Framework.

The five vendors include, notably, Epic, along with athenahealth, eClinicalWorks, NextGen Healthcare and Surescripts. While the Carequality team might not be couching things this way, to me it seems likely that it intends to roll on past (if not over) the CommonWell effort.

Carequality is an initiative of The Sequoia Project, a DC-area non-profit. While it shares CommonWell’s general mission in fostering nationwide health information exchange, that’s where its similarities to CommonWell appear to end:

* Unlike CommonWell, which is almost entirely vendor-focused, Sequoia’s members also include the AMA, Kaiser Permanente, Minute Clinic, Walgreens and Surescripts.

* The Carequality Interoperability Framework includes not only technical specifications for achieving interoperability, but also legal and governance documents helping implementers set up data sharing in legally-appropriate ways between themselves and patients.

* The Framework is designed to allow providers, payers and other health organizations to integrate pre-existing connectivity efforts such as previously-implemented HIEs.

I don’t know whether the Carequality effort is complimentary to CommonWell or an attempt to eclipse it. It’s hard for me to tell whether the presence of a vendor on both membership lists (athenahealth) is an attempt to learn from both sides or a preparation for jumping ship. In other words, I’m not sure whether this is a “game changer,” as one health IT trade pub put it, or just more buzz around interoperability.

But if I were a betting woman, I’d stake hard, cold dollars that Carequality is destined to pick up the torch CommonWell lit. That being said, I do hope the two cooperate or even merge, as I’m sure the very smart people associated with these efforts can learn from each other. If they fight for mindshare, it’d be a major waste of time and talent.

Is Practice Fusion Heading for an IPO?

Posted on January 21, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The New York Times recently reported that Practice Fusion is said to have hired JP Morgan Chase to evaluate an IPO. Here’s a look at the estimated IPO number for Practice Fusion according to the New York Times:

Practice Fusion later created a way to estimate its I.P.O. valuation if revenue came in at $155 million in 2018 instead of $181 million, according to one of the people. Using the lower revenue assumption, the company could command a valuation of $1.1 billion to $1.2 billion if it goes public. It is unclear if the lower revenue estimate was made in response to the market turmoil.

Practice Fusion itself is of course not really commenting on their plans for an IPO or not. However, since it has raised $149 million to date at a valuation of $635 million, you have to imagine that an IPO is in their future. However, many big silicon valley companies have stuck to the private market lately and avoided the IPO. I’m not sure Practice Fusion will be in a similar position to them though. A look at their revenue numbers is one indication of why they’re a bit different than other companies that have raised larger rounds in the private markets:

Practice Fusion’s revenue was $26.9 million in 2014 and was expected to increase by 71 percent to $46.1 million in 2015, with the company projecting it would pare losses by 40 percent to $25.8 million in 2015, according to the document prepared by bankers and the company.

At the time the document was prepared, the company estimated revenue would hit $70 million in 2016.

I personally think that an IPO is in Practice Fusion’s future. It’s just a question of when it will happen. Certainly the market volatility we’ve seen lately isn’t helping their case to do an IPO. However, I bet the bigger challenge is going to be creating attractive revenue numbers that make sense to the public markets. I believe public markets have a hard time valuing number of users and other metrics that make Practice Fusion look attractive.

Ever since the first venture capitalists asked me about Practice Fusion, I’ve said that the company has created value. The number of doctors they were able to sign up on their platform was impressive. That’s the power of offering something for free that other doctors pay hundreds of thousands of dollars to buy. No doubt their network of physician users is a valuable asset. I hope it is since they raised $149 million to build it.

The real question for me around Practice Fusion isn’t whether they created value. Instead, the question is how valuable is what they created? I once heard Peter Thiel suggest at their user conference that Practice Fusion was building the platform for healthcare. Building that would be worth multiple billions of dollars. However, Practice Fusion hasn’t built anything close to that since Practice Fusion is doing nothing in the hospital EHR space. It’s naive to think that Practice Fusion could compete in that piece of healthcare. Not to mention they have a very small part of the hospital owned ambulatory practice space where the trend is to go with the integrated hospital EHR solution.

Long story short, I think that Practice Fusion will do an IPO. I could even see them doing an IPO for a billion dollars. I’m sure that’s what Ryan Howard, Practice Fusion Founder and former CEO, wants so he can claim his startup unicorn status. Although, I’ll be interested to see how Practice Fusion’s revenue grows between now and an IPO. The golden age of EHR is over and we’re entering the dirty slog of EHR sales and EHR switching. I don’t think that makes for a compelling story for investors.

The EMR and the Doctor-Patient Relationship

Posted on January 19, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I was included on what I’d consider a tweetstorm about the EMR and they ways it can impede the Doctor-Patient relationship. I thought many of you would find his comments interesting and might want to add to and extend his comments.

Those are some strong opinions? While I’d love to visit his office, I don’t really need to visit it. I’ve seen many doctors not use the computer in the exam room so they could focus on the patient. In fact, I’ve seen the whole spectrum of computer use in the exam room from a lot to none. My conclusion is similar to the one that Amy Hamilton described here. The setup can really impact the experience of the patient.

I do agree with Dr. Ashinsky that many doctors are spending too much time on the data/computer and not enough time on the patient. That doesn’t mean that the data isn’t important, but many have taken it too far.

What do you think? Does the computer get in the way of he doctor-patient relationship?

Eric Topol tweeted one suggestion:

Software Is Dramatically Better Than Paper – Even if EHR Is Far from Perfection

Posted on January 14, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

After writing my piece yesterday on the reasons so many physicians are burnt out and my previous New Year’s post on physicians getting pissed off, I thought it might be good to add a little more perspective to the discussion.

In a perfect act of serendipity I came across this great article with quotes from Ross Koppel, scholar in the Sociology Department & School of Medicine at the University of Pennsylvania. First, he puts the situation many organizations find themselves in:

If I buy a toaster and my wife says, ‘It’s lousy; throw it out,’ to preserve domestic tranquility I throw out the toaster and buy a new one. If I spend $1.2 billion or $1.7, I am married and I don’t have a heck of a lot of options.

Then he offers what I think is a proper reality check:

There has been increasing rage on the part of physicians and others about the software not being responsive to their needs. That said, I would be the last person on Earth to argue we should go back to paper. The software is dramatically better than paper. [emphasis added]

I’m sure that some doctors will come on this post and start to point out the virtues of paper. No doubt, there were a lot of good things about paper. A long time ago I wrote a post that described the perfect interface that was infinitely flexible, multi-lingual, no training needed, etc and I was just describing the virtues of the paper chart. I get the paper chart was great for a lot of reasons, but it was awful for a lot of reasons as well. I’m reminded of this post called “Don’t Act Like Paper Charting Was Fast.” I won’t even mention how much time was wasted trying to read illegible charts or searching for the chart that could not be found. Oh wait, I just did.

The problem with all the benefits of EHR is that we quickly take them for granted and promptly forget about them. However, the problems and challenges stare us in the face and annoy us every day. Let’s just reconcile us to the fact that the Perfect EMR is Mythology. However, in many ways it’s better than paper and I don’t see anyone going back.

Here’s where I usually do my sidebar and say that doesn’t mean that EHR vendors can’t do better. They can and should. Hopefully the meaningful use handcuffs that we put on them will indeed be removed and they can focus their attention on making EHRs better as opposed to government regulation. Every EHR vendor I know would celebrate this as well!

If you can’t celebrate the small but powerful benefits of being able to read everything in your EHR and being able to instantly pull up every record. We’ve seen glimpses of other benefits coming to your EHR that are great. Take a second to talk to Jimmie Vanagon about how his #ProjectedEHR and patient portal has changed how he sees and cares for patients.

Want to see other innovation happening in the EHR space? Learn about what Modernizing Medicine is doing with EMA Grand Rounds and Watson. The grand rounds approach is genius and can really inform the care a doctor provides. Unfortunately, we don’t hear much about it, even from them, because I don’t know anyone who’s based their EHR buying decision on if it would improve care in their organization. Sure, they didn’t want it to decrease care, but did they really evaluate the EHR based on it’s ability to improve care? No. They ask if it would meet meaningful use. They ask if it will improve reimbursement. They ask if it will improve productivity. Where’s “Will it improve care?” in that list?

Chew on that concept for a minute. How many EHR systems were bought in order to improve care?

What would it take for a healthcare organization to be ready to make an EHR selection based on the care that an EHR system provided? Would the current crop of EHR vendors be able to adapt? Would it require a whole new breed of EHR software (or maybe a different name)? Will any of the current EHR vendors adapt enough that they could illustrate that their EHR improved care so substantially that it would be nearly malpractice for a healthcare organization to pick any EHR but there’s? Is this what we need to happen for doctors to love EHR?

As I wrote at the New Year, I’m optimistic for healthcare IT. There’s so much potential for us to better utilize technology to improve healthcare. There’s so much non-technology that could benefit healthcare as well. Sometimes it’s just baffling that we can’t get out of our own way. What is clear to me is that we’re not going back to paper.