You know, when you think about an EMR purchase, it’s obvious that there’s plenty of technical considerations involved. But the truth is, when it comes down to it, most doctors will never need to know anything about APIs or coding or middleware before they pick out a system. They just want the EMR to work.
The thing is, they’ve already made a big investment in technology before — maybe lots of times — even though they probably know little or nothing about how the gears really mesh. I’m talking about automobile buying, of course. I sort of doubt a single doctor has ever sat through a Webinar on the difference between anti-lock and regular brakes, the advantages of added cargo room or the physics of improved gas mileage. But they still buy cars, don’t they?
No, like everyone else, I’m sure your average doctor takes in commercials, makes a few mental notes as to how the promised benefits fit into their world, digests the information a bit and then goes shopping. At that point, they’re briefed on what features the car has, and tell the salesperson whether that works for them. Ultimately, they buy something that fits their budget, their needs and probably, their self-image too.
Now, an EMR isn’t a fashion statement — while cars most decidedly are — but in other ways, the purchasing process should be similar.
After all, the software they’re choosing should be as utilitarian as an SUV. They should come to the buying process knowing what needs they’re trying to address (in a car, say, the ability to haul big objects, or in an EMR, being able to enter patient notes quickly and clearly). Hopefully, they have a sense of how they’re going to use their EMR on a day-to-day- basis, as they obviously do when they’re car shopping.
And with any luck, they’ll also know what ongoing problems they’re trying to solve, be they managing the flow of laboratory results, making sure they’re reminded to follow up on preventive care, looking at the health of their patient population and so on.
If a practice knows these things, they won’t be blinded by a blizzard of technical terms or worry about whether they’re on version 2.15 of the latest build. They won’t have to spend much time debating over whether a SaaS or client-server solution makes more sense. They’ll just want to get the job done.
Unfortunately, it’s hard to get to that point when a technology comes in looking all scary, complicated and expensive. But as any one who’s ever bought a new car knows, you can always take the damned thing back.
As I look out my office window at a sea of cars in the parking lot, I realize that I could get in any of those cars and drive home without much more thought than where to put in the key and how to switch from park to drive.
Perhaps, one day, all EMRs will be this easy to use and learn.
I don’t agree with automobile purchasing as a desirable analogy. The analogy just does not fit putting together a highly versatile system such as an EMR. I think it’s more like remodeling a kitchen. When you start on your kitchen you may have a general idea of what you want, but you’ll likely need a designer and a contractor. Anyone who has gone through this knows there’s a lot of detail involved and you have to keep a constant eye on price. For example, you’ll need to look at issues such as major appliance choices and locations, cabinets, electrical plans, not to mention hardware, colors, finishes, etc.
The auto analogy also has one other failing. Automobiles are not the product of an unregulated system. Anyone can go into the EMR business as we’ve seen from the abundance of mom and doc operations. If you want to market a car, you have to meet a host of federal and state safety, environmental and disclosure requirements. You can’t sell a car without seat belts, but you can sell an EMR without a report writer. Cars are easier to choose among because there are some uniform standards in each model. Even if EMRs eventually have their own uniform requirements, they still will require much attention to customization to work well.
Nice comment, Carl! One big difference is that car buyers are protected by lemon laws. I’d imagine that EHR adoption would take a giant leap forward if physicians were protected by an EHR lemon law.
Good point, the Federal Trade Commission’s regs and state laws protect buyers against lemons or being high pressured. The only protection a practice really has is the agreement it has with the vendor. If the agreement doesn’t define acceptance terms, guarantees, support, etc., then it is stuck.
It would be wonderful if vendors would adopt a uniform set of contract provisions as the American Institute of Architects has done. Their system is not perfect, but its better than nothing which is what EMR buyers have.
These are all excellent points. I do realize that the car analogy isn’t perfect, but as we’ve seen here, it’s not a bad jumping-off point to start a discussion on what doctors would need to feel safer buying an EMR. So far we’ve got:
* A legally-mandated core set of required elements that all EMRs would need to have
* A “lemon law” regulating EMR sales practices
* Self-regulation from within the industry as to how products were configured (as per the AIA example)
Anything else?
-Katherine
Katherine, you could add to the list “EMR Reform”… a concept that I floated in August 2009 that I believe would spur EMR adoption:
http://blog.srssoft.com/2009/08/emr-reform-a-plan-to-spur-adoption/
I also like the car analogy since I don’t know anyone that would buy a car without a test drive. Yet, many people will buy an EHR software with little more than a demo. There’s some real value in “test driving” an EHR software before you sign on the dotted line.
Katherine, when I go shopping, I look for sites like TireRack. While they sell tires, they give potential buyers a host of useful information. Some of it’s just the numbers, but they also do a lot of hands on driving as well as user ratings.
I’d love to see something like that for EMRs. There are some precedents. Some conferences have EMR shootouts. They give each EMR a particular task such as renewing a prescription and then see how each performs.
I’d love it if you could go to a site and get basic data such as response times, costs, certifications, etc., and then see the system put through its paces for several, standard operations such as how it would be used during an encounter.
Doing this would not be easy or cheap. Our site ehrselector.com does features by charging both users and vendors a subscription fee. It would be good if we could do it without cost and even better if we, or someone else, could do a full performance review and make it available to all.
You are correct in stating that physicians should know a few things before they acquire an EHR system. However, you didn’t state the first essential step. The physician should have a business plan that includes an information technology strategy. Now I’m not talking rocket science here. This is just a few statements on what the physician expects to achieve in his practice over the next few years (business plan) and how information technology can be used to reach those goals (IT strategy).
This simple exercise will answer 100’s of questions for the physician when he is considering EHR and, most importantly, will do a lot in answering the big question, “Will EHR bring benefit to my patients and/or practice?” It will also set his expectations when he is looking for the “perfect” EHR.
Physicians seldom rush to conclusion on healthcare issues but for some reason they want to rush to conclusion on EHR implementation. Maybe it is because they don’t understand it or maybe it is just too big of a change for them to accept. Whatever the case, the lack of preparation will guarantee the physician is not satisfied with his EHR implementation.
The changes taking place in healthcare today and specifically Health IT will serve either to increase the role the physician plays in the future of healthcare or it will decrease it. That is largely up to the physician. An EHR can deliver either much benefit or many problems to the practice and the patient. That also is largely up to the physician. If he want to purchase his EHR the same way he purchases his automoibile then he shouldn’t be surprised when he gets a “lemon.”
Carl,
I’ve seriously considered holding an EMR conference a number of times that would do some of what you describe. Basically dig into the real core of an EMR. Give doctors a real feel for the good and the bad of an EMR. I think the key challenge to doing so is finding the right way to attract doctors to the conference. Once you have doctors, all the rest is pretty easy to get.
Dan,
Nice insights. I think what you described is why we can see some doctors who implement their EHR successfully and love it while others struggle with it and often end up switching later at great cost to them.