Quick Tests to pick EHR by

This is a short article crediting another author for creating the criteria with which to select an EHR. There are so many vendors and so many sales people out there telling you their wares are the best but little assistance for the medical practitioners who need to choose these tools in the time that they do not have.

For those as confused as I was a couple of weeks ago about these jargons, an Electronic Health Record system (EHR) is a superset of Electronic Medical Record (EMR) and Personal Health Record (PHR) systems.  The stimulus money from the Obama administration to encourage the adoption of software technology in medical practices is for EHR as it requires the introduction of both clinic and patient facing features.

This is the original posting by Peter Beck from which the summary below was created:

  1. Any Information To Be Filed Must Have Doctor Approval Or Awareness
  2. External Resources To Take Care Of Scut In A Cheap, Dedicated Fashion = PASS
  3. Get Doctor Signoff Before Proceeding With System Changes — Repeatedly
  4. 1-Click Is Best, 2-Clicks Is Status Quo, Anything Else…Not So Good
  5. Pare With Care
  6. Always Customize By Provider, If You Have The Option
  7. If Something Works, Copy It Shamelessly

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Why do doctors hate EMRs?

While trolling the web, I found this great article written by a physician about why doctors hate EMRs.  Electronic Medical Records, or its cousin EHR and even PHR, are supposed to help physicians provide better quality care to patients, ideally at lower costs to the society.  However, as you can see in this article, http://www.dillingerkovach.com/accusourcecareers/?p=10501, the adoption rate is abysmal.

As a software guy, and having studied cases of why Business Intelligence and other other enterprise software systems suffered poor adoption among their intended users, I can almost predict the usual barriers to adoption.  What makes the EMR case more interesting is that in small clinics, the physicians tend to be the buyers of the software too.  If they are unhappy with the product, they would simply not buy an EMR or abandon it after paying for it.   Those who are in larger enterprises (aka large clinics or hospitals), the unhappy docs will find anyway they can to get out of using it.

Why, you may ask, are these doctors so recalcitrant about technology?  The author said technology was not the problem.  According to him, docs use much more sophisticated technology everyday – MRI, cyro-probes, laser, etc.  Instead, it is because “It slows them down!”.   It isn’t the first time I hear this from a doc.  If you are in the business, I am sure you know this tune too.

Most EMRs, similar to ERP and other enterprise software, suffer from the same shortcomings.  Told poignantly by the author in this excerpt, the consumers suffer from a sign at a dry-cleaner’s shop reads: Low Prices, High Quality, Fast Service: Pick One. I am optimistic that we can get to a place where EMRs not only contribute to better care, lower costs and also user satisfaction (physicians’ and patients’).  It wouldn’t be trivial.  Some vendors won’t make it through.  If you have answers to the questions that the author raised in the article, I would love to see your comments.

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The slow revolution in Healthcare IT

For years, healthcare IT has been dominated by big players and arcane system architecture that resembled the ERP market in the 1990s.  Playing into this is the vendor dominated CCHIT certification process, which required everything under the sky to pass, but did little to ensure the software support a better care delivery or even integration with the disparate systems used by different physicians.  However, there are reasons to be optimistic as 2009 comes to a close, as written in this blog.

Looking at healthcare IT, I see a lot of parallels to how the enterprise IT space has evolved over the last 15 years.  There were many promises and much money spent, but little to show in the form of tangible quality improvements or cost savings.  Sure the marketplace will eventually sort out winners and losers, but I postulate that government stimulus money will make the outcome of this evolution different.

Granted, what needs to happen in this space isn’t limited to just moving the power from traditional HIT vendors.  The interoperability in HIT in general is abysmal.  Even new vendors aren’t much better at allowing physicians and patients share data.  However, there are reasons to be optimistic that people building HIT software would consider a multi-tenant system or a data sharing platform a fundamental requirement instead of an afterthought.

What do you think?  I am especially interested in hearing from those who are involved in healthcare delivery.  After all, I am peddling wares just like everybody else.  You the user should have the final say.

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