I’m ready to call the Golden Age of EHR Adoption Over. We’re not getting ready to enter the nasty, ugly, dirty, swamp filled waters of EHR adoption. If you’re an EHR vendor you likely already know this to be the case. That’s not to say that there’s not still real opportunity in the EHR space, but it will take on a very different form.
I think this image of the adoption lifecycle describes the EHR adoption cycle really well. I’m sure it will be familiar to many of you:
It’s very clear to me that we’re somewhere in the middle of the Late Majority cycle of EHR adoption. This plays out well since we’re somewhere between 50-84% EHR adoption. While the chart shows a downhill slope, the ride to get the Late Majority and Laggards on EHR is going to be anything but a downhill ride. I’d say it’s going to be more like climbing Mount Everest. It’s possible, but it’s going to take a lot of work.
The reality is that those who wanted to adopt EHR already have adopted EHR. That means we have left a group of practices and hospitals that for the most part aren’t EHR convinced. However, there is one advantage for those wanting full EHR adoption. Almost all of those who haven’t adopted EHR see the writing on the wall. They’re just going to take their time and make a deliberate choice based on the experiences of those around them.
EHR vendors will now start to focus on creating what I call Smart EHRs. Doing so will be how they battle each other in the next wave of EHR switching. Plus, this will usher in the next EHR Golden Age: Use.
Future Golden Age of EHR Use
While the golden age of EHR adoption is over, we’re entering a new EHR Golden Age. It’s the golden age of amazing EHR use. It’s still very early in this new cycle, but the innovators are going to really surprise us with the innovation that’s going to be possible on the back of an EHR.
Many of the changes will be subtle and we’ll take them for granted almost instantly, but they will be amazing in aggregate. Take for example, Jennifer’s recent post on EMR and EHR about her child’s well visit. How beautiful is it that her child’s record was available at a new clinic with no effort on her part. We’re not there yet, but we’re going to get there. Although, we wouldn’t get there if we were still at 25% EHR adoption.
Jennifer’s example is a simple, but powerful one. No doubt there are going to be much more complex and much more powerful examples to come. Many of which will actually save people’s lives.
The Golden Age of EHR Use is going to bring about dramatic benefits that would have never been possible without massive EHR adoption. The Golden Age of EHR Use will be so good that even the EHR adoption laggards will finally want to change.
Just saw a Medscape piece surveying MD/JDs who defend malpractice suits via the Pathology Blawg, and they cited EHR as a major source of malpractice exposure. Early studies (of early adopters, natch) showed EHR reducing malpractice incidence, and I wonder if the “nasty, ugly, swamp-filled waters” of adoption by a less tech-savvy cohort may be behind these disturbing observations.
Smart EMR? Did someone say smart EMR? 🙂
I encourage folks to take a look at “context aware computing”.
I’d argue that smart EMRs are adaptive, responsive, proactive, and capable of autonomous action.
From…
http://ubiquity.acm.org/article.cfm?id=764011
“Adaptive systems: these learn their user’s preferences and adjust accordingly….
Responsive systems: these anticipate the user’s needs in a changing environment.
Proactive systems: these are goal-oriented, capable of taking the initiative, rather than just reacting to the environment.
Autonomous systems: these can act independently, without human intervention.”
Learn, anticipate, goal-oriented, initiative, independent…none of these describe the behavior of today’s typical EMR towards its users. As a consequence physicians must compensate with a torrent of clicks (so-called “clickorrhea”) to push and pull these EMRs through what should be simple patient encounters.
And yes, there’s a connection between context-aware computing and process-aware workflow.
But then you knew I’d bring up workflow…!
–Chuck
Paul,
I’ve seen studies on both sides of the malpractice discussion. Some say you’re more at risk and some say you’re less at risk.
Chuck,
I think you’re talking smart workflow, not smart EHR. They have a relationship, but are a bit different.
John,
Smart — intelligent, (in a device) capable of independent action
Workflow — series of steps, consuming resources, achieving a goal
What else is there?
–Chuck
John, great post. Technology adoption is directly related to ease of selection/implementation/use. Innovators and early adopters derive a secondary benefit from technology adoption — the thrill of discovery/adventure. Those who come along later, generally speaking, just want things to run when they press a button. (http://ehrscience.com/2012/09/10/how-does-ehr-design-affect-implementation-and-optimization/)
It will be interesting to see how slowing of the EHR adoption rate (whether through recalcitrance or saturation) affects vendors and consultants. (http://ehrscience.com/2012/06/25/the-ehr-market-and-biology-101/)
Jerome
Independent action means no workflow.
Independent action means no series of steps, consuming resources, achieving a goal?
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