It's Not About Meaningful use... From THB

John Moore has yet again cut to the chase and stimulated some great discussion over at the Health Care Blog. I encourage everyone to go there for the full discussion. I could not help but create some excerpts:

...adoption hurdles are not so much about MU criteria, but more about productivity losses in adopting an EHR

...EHR, from one of the big names in ambulatory systems, has been a complete disaster for the clinic.

...The clinic puts the blame squarely on the EHR, which has severely constricted their ability to see patients and as all readers know, clinicians get paid for seeing patients, not trying to use a complex and difficult to use EHR. They are losing money far in excess of what HITECH Act incentives will provide. This story is, unfortunately, not unique, though few EHR vendors will come clean on the productivity hit to a practice.

...Workflow is always a challenge but rarely if ever should one try to code existing workflow practices into a new enterprise software solution be it ERP or EHR. A recipe for disaster. A very delicate balance must be struck between adopting out of the box workflow and customization to existing workflow practices. Careful review of a vendor's solution is required to best match capabilities to needs (doubt many in this industry, esp small practices, have the skills to do this assessment correctly and doubt RECs will be much better).

Then, some real pearls in the comments:

...Many physicians with whom I speak are angry that anyone, including the government, could be so tone deaf as to suggest they should adopt technology that creates even greater economic stress.

David C. Kibbe, MD MBA



...Technology is supposed to help but most vendors don't get why and where they're the problem.

Until we design software and/or devices that take into account the different contexts a clinician finds himself/herself during their daily workflow we will have little success in getting them to implement technology.

Other factors that bring down productivity while implementing an EHR or EMR are:

1. Low clinician buy-in,

2. No clarity or a roadmap that others can follow, the implementors don't understand the needs of the clinicians and the clinicians have no idea what is going to happen next,

3. Lack of training before implementing,

4. Poor workflow analysis, cookie-cutter approach is detrimental to the practice/clinic,

5. Lack of a champion withing the practice/clinic,

6. Poor support, most vendors have very few support people to follow-up on the implementation,

7. Complexity of software, most try to do so much that they end up doing very little,

These are just a few of the ones I have encountered in a career lifetime of implementing software in hospitals, clinics and practices.

The EHR Guy



...According to the top doc at Sermo, 80% of docs feel EHR is good idea but few feel they can afford the upfront/ongoing costs and productivity disruption they inevitably induce.

I feel that the industry would be better served by first implementing the technology that has the capacity to improve care, lower costs, and at least maintain the status quo productivity.

Thomas Schwieterman MD



...I completely agree with Dr. Waldren's analysis. If you look at industries that used IT to computerize the business and realize efficiency, they all automated very well defined manual processes. There are very few of those in health care, and the ones that are standardized enough, like prescribing meds, or billing, have been computerized successfully.

...many doctors come to expect that implementing an EMR is like buying a new car. Sign the check and drive away. It is not. It's more like getting new orthodontic braces.

...I am not sure why, but these very well prepared physicians, seem to understand that implementing an EMR is a process, not a task and they are in for the long haul... They demand training and on site support and often are willing to pay the extra dollars...
At the other end of the spectrum are the physicians that just want an EMR because everybody is getting one, and "would you be so kind to have it installed while I'm on vacation next week?" (real story). These folks will fail miserably and suffer all the way through.

Practicing medicine is probably more complex than flying a plane, and the software to assist in medicine is probably more complex than the software assisting the pilot. In both cases, it takes time to become proficient, and the expectations should be set accordingly.

The Government has asked for input on their proposed EHR certification model. Why not submit your comments, so the Government gets an idea of the prevailing concerns out there?

You cannot affect change unless you make your voice heard.
The comments are public, thus cannot be ignored.

Here is the URL for commenting. You have until 5/10/2010.
http://www.regulations.gov/search/Regs/home.html#submitComment?R=0900006480ab9d0e

Margalit Gur-Arie



...Human factors and making the software work into existing ways of working are usually the weakest point because that requires initial observation and incremental interaction with the users to find out how they would best interact with the system.

Wellescent Health Forums



... This post and it's subsequent thread reveal a truth I have seen since the beginning of my interest in RHIOs and HIE way back in 2003. IT is seductive, everyone thins IT can do things doctors and hospitals cannot. I've used several EMR systems and none of them save time. First of all it turns me into a secretary and I have to assume other peoples' duties. The IT application may improve efficiency by allowing bureaucracy to rule, and also by shifting more of the work load to the physician. One has to delegate many of the systems functionality to nurses and others such as e-prescribing with the physician reviewing and signing off...

Gary L