I’ve been really falling in love with some of the content that the Health Affairs blog has been putting out there lately. A recent post titled “The EHR Has No Clothes” was no exception. In this incredibly thoughtful post by Barry Saver, he’s not afraid to start a discussion about points that many are afraid to talk about. I like that a lot. Although, I think the post also represents a couple ongoing trends I see in EHR perceptions.
Common EHR Problem 1 – I can’t tell you how many times I ask a doctor how they like their EHR and then they provide me some small facet of the EHR which annoys them. In Barry’s case it’s “Most screens do not show age, date of birth, or medical record number.” While we could delve into the particular feature that Barry mentions, that’s really not the point. The point is that far too often I see users of EMR systems fixating on one particular issue and ignoring the dozens of other items that are better than the paper world. It’s the proverbial throwing out the baby with the bath water.
No doubt I have a little Pollyanna in me. Although, I should be clear that I’m not suggesting that EHR problems shouldn’t be addressed. Please do hold EHR vendors accountable if their software needs changes. I am saying that I see far too many doctors and clinics that get so fixated on one problem that they ignore all the other good things that are possible. There are deal breaking EHR features and their are EHR annoyances that can be fixed. Make sure you know which one you are really dealing with when you see it.
As an interesting sidebar, this same fixation often happens in the EHR selection process. Although, in this case the person selecting the EHR often fixates on some particular feature (valuable or not). For example, they’ll say that they really love the login screen or background color. It’s amazing what little things can have such an influence on our decision making when they shouldn’t matter at all.
Common EHR Problem 2 – I’ll call this problem the mature feature problem. It turns out it’s a fallacy to assume that a mature EHR (ie. one that’s been around for a long time) has had time to fix all the problems. Here’s a short paragraph from the above linked post:
Approving 12 months of refills when I receive an electronic refill request typically takes a combination of 14 mouse movements, clicks, and keystrokes – as opposed to four if it were implemented efficiently. The list of items needlessly making it more difficult to provide efficient and effective care would cover many pages. These might seem like issues that could be present in version 1 of a system and then promptly fixed, but we currently have version 5.6.
I’ll save the discussion of mouse clicks and keystrokes for another post since it’s an important one. Instead, let’s focus on the idea that a mature EHR will have worked out all the issues with certain features. While this can definitely be true in the early development of EHR software, the opposite often comes into play as EHR software matures.
When an EHR begins its development life cycle it’s usually only saddled with a very specific task. In fact, you don’t have time to build all the features so you often have to make it really simple because of time constraints. Assuming this meets your workflow, it’s a great thing and you enjoy a wonderfully simple interface. Over time, features continue to be added to the interface. Plus, they have to start supporting all 50+ medical specialties that all have their own specific needs. Quickly, the beautiful EHR interface gets bloated to the point that it can do everything imaginable, but it does nothing really well.
Certainly, the best EHR software vendors know this and battle against it. Although, it really takes a battle to overcome this challenge.
What I find even more ironic is that Barry suggests Vista as the solution to his issues with EHR. At least he admits to never having used it other than the demo client on the web. Certainly Vista has its place in the EHR world and I love that it’s open source and benefiting from that innovation. Although, I think it’s crazy to think that a small doctor’s office is going to implement Vista. I’d love to see Barry do a write up after he adopts Vista.
Does the EHR have no clothes?
I think many EHR companies do have clothes on. I think the real problem is that we need to just stop shopping at the high end stores by the nude beach.