Electronic Medical Records…
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Lots and lots of chit-chat throughout the health care and political communities these days about how electronic medical records (so-called “EMRs”) are going to reduce the cost of health care and improve quality. By themselves, they mean nothing, and we should all get a grip on ourselves about this before it gets completely out of hand. In simplest terms, an EMR is just a hammer. It’s the quality of the carpenter that determines whether or not it makes a difference.
Do I think health care is under-invested in clinical information technology? Yes. Do I think more EMRs could make a positive difference? Yes. Do I believe that EMRs, all by themselves, will assure cheaper, better health care? No. Absolutely not. Even in theory, this is a big lift. It’s the way people choose to use the EMRs that determine their relative effectiveness, and there’s nothing about an EMR that forces more collaboration and connection between and among separate departments treating someone with diabetes. It can enable that interaction, but it can’t make it happen on its own.
EMRs will be a big improvement - are already, in places where they’ve been adopted - over the traditional paper-based medical record. But we have a long way to go in implementing EMRs across our paper-based medical record system, and we’re even farther away from recognizing and appreciating the possibilities that come with EMRs. For example, some health care delivery systems have installed EMRs as a way to encourage their patients and clinicians to use only their care delivery system, by making them unable to communicate with anyone else’s EMR. Imagine, if you will, a world in which you could access only your own bank’s ATM, and no one else’s, because banks all believed that making you use their own systems was the best way to keep you as a customer. This is hardly using clinical information technology to improve quality and reduce costs.
Remember, an EMR is just a hammer. It’s the carpenter who determines how much of a positive difference it can make, and on that one, we have a long way to go.
Mr. Baker;
I agree with your basic premise that EMR’s by themselves will not revolutionize health care. However, I submit that the biggest problem is not the carpenter but the manufacturer of the hammer and therefore the hammer’s quality. As a clinician veteran(or perhaps the correct term is victim) of several hospital computer installations, I can tell you the vendors have little idea of what makes a truly functional health care computer system. Although they are advertised as having the ability to “transform clinical work processes”, that is just a euphemism for the fact that the work process must conform to how the computer will allow you to perform it - and many are a step backward rather than forward.
I agree that the carpenter is limited as yet, in many cases because the providers are led by older leaders who are not as computer-savvy as our kids, and therefore lack the vision of what a good system can do. BUT - they’ve got to have a good tool to work with first. In addition, it’s the vendors who oppose interoperability of different systems more than the hospitals, due to obvious profit motives.
We desperately need a Steve Jobs-like visionary in health IT who will transform the industry nationally.
Mr. Baker,
I submit to you that the only way to measure clinical quality is with clinical data. Capturing clinical data generally requires use of some sort of EMR. Administrative data falls short of providing real high value metrics other than cost data in my opinion and according to available studies. Until EMR technology is prevalent, there will not be accurate clinical quality.
br,
Blaming the software in a blanket statement is a tired and simplistic argument. The vendors have improved and EMR software has been demonstrated to work well for many practices. There are also clearly many failures (including some rather famous and expensive catastrophes). Yes, a practice must accept that there must be significant change to workflow and optimization to be performed when implementing an EMR. Workflow can be optimized in ways that improve processes when the right team is cross-functional team is assembled. Sometimes vendors fall down on workflow consulting which causes more failures than inadequate technology. Other times physicians refuse training or don’t participate in the clinical workflow redesign process. Often it’s a combination of these factors. If physicians want successful EMR implementations, they must be very involved in the whole process, willing to change, and play well on a workflow redesign team. This is often more time and effort that physicians are willing to bear.
Interoperability will continue to be an issue in large part due to the complexity of medical data. It takes companies to play nice which is a challenge but HITSP (Health Information Technology Standards Panel) and CCHIT (Certification Commission for Health Information Technology) are a good running start towards the goal of interoperability.
AA;
I assume you are a physician office EMR vendor. Don’t call it tired and simplistic until you’ve tried to work one of the darned things while trying to take care of a patient at the same time. And by the way, my comments were directed toward systems in hospitals, which are the only ones with which I have any experience, being a hospital-based physician. I can imagine trying to implement one in an office would be an even bigger nightmare, although on a smaller scale. But you’ve hit the nail on the head when you say sometimes the vendor falls down on workflow consulting. Keep in mind you are not selling to people who are familiar with how to integrate these things into processes they have used for years.
br - Fair enough. The IT guys probably over-promise on their ability to simply digitize existing processes for providing and documenting care in a practice or a hospital. That said, most of us who’ve been through one of these, and I’ve been through several, know that one of the benefits of installing a new system is the opportunity check up on - and change - existing ways of doing business to adjust to changes in the way the information can be collected, stored and manipulated. It’s sort of like spring cleaning - on a much grander scale - and it’s usually a good opportunity to re-think and reconsider our standard way of working. That’s not always a bad thing.
I think it’s important to evaluate (and then anticipating!) the true cost of an electronic medical record system implementation. Too often, physicians focus only on the upfront costs, and forget that it takes a fair amount of time and resources to maximize their new system.
This isn’t to say you shouldn’t pay attention to upfront costs - some systems require an unreasonable initial investment - but even the cheapest systems will require extra effort upon “go live”.
Bottom line: Do your homework, make a selection and invest a lot of energy in making your system work well in your office. By far, the single greatest post-purchase investment is your own time and energy. It will take a few months to learn everything about your system. Even the easiest systems require work - unfortunately, all of your problems WILL NOT go away simply by flipping the EMR switch. DON’T GET FRUSTRATED! Stay focused and you’ll soon reap all the incredible benefits of an electronic medical record software system.
EMR Software Guy,
http://www.electronic-medical-record.blogspot.com