In one of my many recent conversations or readings about EHR, I had this really interesting question come into my mind:
Can a Patient Focused EHR Sell?
At the core of this question is another question: Why do doctors buy and implement EHR software?
As I process these two questions, I’m once again faced with what I call a perverse set of incentives in healthcare. Turns out that these perverse incentives are all to common in healthcare and they make me sick when I think about them.
I’m sure many out there would argue that none of the EHR software out there are patient focused. We could argue that point (particularly the word none), but let’s just assume for a second that the EHR software out there today isn’t patient focused. Is the EHR vendor responsible for not making patient focused EHR software or are they just meeting the requests of doctors and clinics.
As I scan through my 6+ years of experience living and breathing EHR, I’m trying to remember a case where a doctor chose to go with EHR based on improving the care of the patients. I can think of a few incidents where patient care had a subtle after thought. By far, the most common reasons for implementing an EHR have been about the impact to the doctor and/or clinic. Most of the reasons are financial or lead to financial implications.
Which EHR sounds better to doctors?
-Improved Efficiency
-Increased Reimbursement
or
-Better Patient Care
-Improved Clinical Outcomes
We could certainly argue some indirect benefits to patients by doctors being more efficient and practices doing better financially. However, in healthcare patients are rarely the direct beneficiaries of any efficiencies that are gained. The doctor, the clinic, and/or the insurance companies usually take those benefits.
I’ve written before about one of the major challenges is that patients: 1. don’t have good ways to differentiate and measure the quality of the medical care they receive and 2. some don’t have a choice of physician because it’s the only physician in that area. These two factors make it so that the quality of patient care (at least within some reasonable norm) has little impact on the number of patients that visit a certain doctor.
This is a challenging question that I don’t have the answer to, but it seems clear to me that the EHR market is delivering the solutions that people are asking them to create. I wish there was a way we could adjust the market to create more patient focused EHR. Maybe the ACO movement will help us get there.
Quick Disclaimer: While this describes general economic motives in the EHR market, I have known a number of people and even some companies in the EHR world that want to do what’s best for the patient regardless of the bottom line. As one EHR vendor CEO told me, “We’ve left money on the table.” I just wish that market forces could be turned to do what’s right for healthcare so everyone would be incentivized to do good.
I must admit, I didn’t read past “Why do doctors buy and implement EHR software?”
That combined with the post title about made me shoot scalding hot coffee through my nose.
There is one reason docs are going to EHRs – they are being forced to.
As I’ve said many times, if I were a physician I would have gone electronic a long time ago – but I’m a computer-centric guy.
Most docs hate this. Most docs see ZERO ROI.
Most docs already have PM software and that is plenty electronic for them…plus ROI is easy to show with PM software.
I would be shocked to come across that one doc who chose an EHR with the patient in mind.
A doc wants:
– Easy to use
– Not crazy expensive
– Little training (easy to use)
– Works like its supposed to
– Easy to use
Two things never on the list:
-Better Patient Care
-Improved Clinical Outcomes
(Yes I did read further…)
Though, when pressed, a doc may state that the increased efficiency (which doesn’t really exist) and better tracking will lead to better patient care and fewer mistakes…not that mistakes were ever made in the past.
I’m not saying any of this is right or wrong, just reality.
I would change the word doctor to ” boardroom CEO”. Let’s not forget the majority of docs are hired employees who do as they’re told.
Also agree with the above comment by John Brewer.
Point taken on doctor vs CEO.
To be clear, my comments are from my experience.
I deal with private practice physicians, not hospitals.
So, all my comments are from the perspective/experience of the private practice physician.
I have not doubt a boardroom CEO & CTO could talk for hours on how an EHR has improved efficiency.
This is definitely an easier argument in a huge operation vs. a small practice.
A patient-centric/focused model as a core component sadly has been omitted from this emerging industry. One day we will look back and realize what an aweful mistake was made.
As noted by Mr. Brewer, the reason docs are buying EMRs _today_ is because they’re being forced to.
But I knew a physician back in 1998 who bought one because she hoped it would lead to better patient care. She acknowledged that it had problems, but after a year or so of using it became a strong advocate of the notion that it did indeed enhance care. She pointed out the availability of a single easy to find/read repository of historical info – tracking pt complaints, looking at med prescriptions and adherence (refills…), surgical options and outcomes, etc. IN essence, she found the ability to refer back to her hand-written text entries for the pts, over time, was very useful in helping her determine whether treatment was satisfactory or changes were needed – she could, in effect, re-read her own impressions of care over time.
When we discussed costs, she was annoyed that there was no way for her to recoup the cost of the EMR directly, but she hoped that its use would increase the quality of her care and thus her reputation in the community. Something worked – she was receiving referrals from hundreds of miles away before hospital politics caused her to decide to fold up the tent and move along.
In today’s EMRs, her entire concept of the EMR is anathema. Free text is frowned upon, if not forbidden, as all data must be entered in a “computable” format. This makes it easy for govt computers to chew on the data, but makes it very difficult for human users of the data to derive anything meaningful from it. Despite being an early and successful adopter of EMR technology, my friend still uses her old EMR and has no intention of attesting for meaningful use. Her CPOE is limited to use within her clinic, but she can do e-prescribing because she worked a deal with some local pharmacies to accept data transmissions from her system and to respond – they split the cost of the consultant who programmed the interface. It doesn’t fit govt criteria, but it does give the pharmacies the info they need to get the meds ready, and she has a record of their use.
My friend is an idealist, and she is a reasonably accomplished computer nerd by avocation. She speaks freely about her system, and back in the good old days actually converted a couple of other docs to the EMR. Today, she still preaches, but doctors are too fearful of MU and the government to consider her approach. What a pity…