One of the better EMR bloggers out there, Margalit Gur-Arie, recently posted what she calls “EHR Mythology 101” on The Health Care blog. Below I’ve copied her major topics and a few comments of my own about each topic. You can read her post for her comments.
The current EHRs on the market are outdated legacy systems
I’ve heard this comment a few times recently. Although, it’s mostly from industry insiders and not doctors. I don’t think doctors really know the difference or know the differentiation. Not because they couldn’t know, but they’ve just not generally invested the time to know the difference. It’s no wonder they come looking for any help they can find to narrow down the 300+ EHR vendors (I heard two people saying 600 this weekend) on the market.
Either way, there’s a reason they’re called legacy systems and the concept of doing agile development on a legacy system is universally bad (not just in Healthcare).
EHR prices are small fortunes
I’m still in disbelief that physicians are still paying small fortunes for an EMR. It’s just CRAZY!! There are so many other options out there.
EHR implementations fail because the software is unusable
Margalitit offered this comment, “[EHR Implementation Failure] has been linked however to lack of change management, poor choice of product, wrong expectations, insufficient training, lack of commitment and all sorts of peripheral lack of preparedness.”
A study to why the implementations fail would be a good one. I agree that unusable software is unlikely to be the real cause for most failures.
CCHIT certification doesn’t mean anything
CCHIT certification doesn’t mean anything. ARRA (HHS) certification does mean something. It just so happens that CCHIT will be providing the ARRA EHR certification. So, CCHIT matters because they certify EHR software for the government same as Drummond Group and likely a number of other certifiers will do. Either way, it doesn’t mean anything for doctors. I have yet to see any study that shows that EHR certification of any type helps doctors in any way. There’s a reason the VP of marketing was on the EHR certification call and not the clinical director. It’s a marketing tool and not a tool for doctors.
EHRs should be like Facebook
True. Facebook is more like a PHR than an EHR. Facebook is definitely different than an EHR, but I think there’s still many things that EHR vendors could learn from what Facebook’s been able to create.
EHRs should be about Clinical care not Billing
Should is the operative word. There’s a lot of things that should happen and then there’s the reality. EMR Billing is here to stay and will forever be a major part of an EMR. However, I think it is worthwhile to consider what an EMR might be like if it was about clinical care and not billing.
Big monolithic EHR products are bad
I heard some interesting discussion about this topic this weekend. I’ll be writing about it more in the future on EMR and HIPAA. At the end of the day, the idea of having one neck to ring when something goes wrong is a big deal. It’s been a big deal outside and inside healthcare and it will win the day in this case too.
Now I’m not an advocate of what I call Jabba the Hutt EMR vendors either. However, you can be a monolithic EHR vendor and not be like Jabba (big, slow to move, dominating, powerful, but have a hard time changing).
Physicians should wait until the perfect EHR is ready
I don’t fault physicians for waiting to know about meaningful use and certified EHR before implementing. However, those physicians who say they’re waiting for the perfect EHR really just don’t want to implement an EHR. There’s no such thing as a perfect EHR. The only perfect thing I know on this earth is my wife.
Unusable software is the most common EMR implementations fail. Developers have shown very little interest in understanding workflow. Physican rejection Is overwhelmingly responsible for the failure of EMRs. Why do we reject? Because these systems are buggy, slow, and riddled with clickorrhea.
Brian,
A recently aired United Health Care commercial sums it up to an extent. In the background, a women’s voice is heard complaining that if her pizza parlor records are online, why not her medical records.
The same companies, developers, tools, platforms, practices, methodologies, UIs, and database designs that “deliver in under 30 minutes” pizza parlor software, also deliver (or try to) EMR software. To a large extent, therein lies the proverbial rub.
As you so aptly point out, we are not looking at a data entry problem.
There is no good electronic physician documentation available. The tradeoff between structured reusable data and human readable information is forced toward the extremes. It doesn’t need to be.