During last week’s #KareoChat, the chat host @GabrielSPerna offered the following tweets from the @PhysiciansPract account for which he is now managing editor (Gabriel Perna was formerly @HCInformatics):
A6: I found it interesting 67.7 % say they have seen no ROI w/ their EHR but less than 20% are dissatisfied w/ their vendor. #kareochat
— Physicians Practice (@PhysiciansPract) July 16, 2015
A6: IMO, this says this isn't as much of a tech problem but a cultural one. If it was tech, they’d blame their vendor. #kareochat
— Physicians Practice (@PhysiciansPract) July 16, 2015
When I saw this tweet, I knew I needed some time to chew on the concept. Do we really blame our vendor when it’s a tech problem? I’m reminded of a time my EHR software ran out of control and was literally chewing up RAM and never spitting it out. I’d restart the server and we’d be fine until the EHR software had chewed up all the RAM again and then the EHR was slow as molasses. You can bet I was blaming my EHR vendor for the tech problems we were having.
However, did I blame them for our cultural challenges as well? I guess the key term there for me is “blame.” I know many practices (and have heard of others) who have switched EHR vendors 3, 4, even 5 times. They loved to blame the previous EHR vendors for their problems. However, by the 2nd or third, you can be sure there are some cultural problems there that need to be resolved. As much as they want to blame the EHR vendor they’re likely not to blame.
Another tweet from today’s #KareoChat seems to also illustrate the challenge is cultural and not technical:
Worth noting that many provides prefer to modify software vs modify their process despite process being flawed #kareochat
— Dr. Tom Giannulli (@drtom_kareo) July 23, 2015
I can already hear Dr. Tom in his EHR product management meetings asking why they’re building a certain feature into the software when it supports a flawed process. The developers respond that it’s what the customer wants. This highlights a major cultural problem.
Back to the original discussion. The fact that many doctors haven’t seen an ROI from their EHR, but less than 20% are dissatisfied with their EHR vendor does seem to say that most EHR vendors have not had tech issues. Instead the EHR dissatisfaction likely stems from a lot of other cultural problems in healthcare.
All of this reminds me of some old posts where I asked “Can An EMR Focus on Patient Care in the Current Reimbursement Environment?” and what would an EHR look like if it was focused on customer requests and not MU? Is the healthcare culture what has created these less than happy EHR users or is that letting the EHR vendors off the hook?
I would not put much stock in that survey. It’s hardly scientific. It only represents the opinion of those who answered it and does not show any attempt to be representative of the medical community.
I have come to realize this to be the case as well. Process re-engineering is very hard to swallow for for any organization no matter what vertical you’re in. In medicine this is typically harder than others as systems and process based thinking is not taken as gospel but as a burden. Until that is the case, the “customer” would perpetuate the problems by asking vendors to support sub-optimal processes. As is often the case, technology tends to further highlight such sub-optimal processes and is also the reason why the vendor take flak for that.