Today, I was lurking in the EMR and HIPAA Facebook chat where some readers and publisher John Lynn were talking of things EMR-related. During that chat, one exchange really brought home to me how far we have to go in even agreeing on how the ideal EMR should work.
During the discussion, one chatroom member said that the biggest problem with EMRs is still that they force doctors to break their workflow. Another stalwart chatroom member, the insightful @NateOsit, retorted that EMRs should break workflow patterns, as this would promote healthy change.
Well, there you have a conundrum, if you look closely enough. While people seldom speak of the issue this directly, we’re still arguing over whether EMRs should fit doctors like a glove or change their habits for the (allegedly) better.
This isn’t just an academic question, or I wouldn’t bore you with it. I think the EMR industry will be far more wobbly if the core assumption about its place in life hasn’t been addressed.
At present, I doubt EMR vendors are framing their UI design discussions in these terms. (From the looks of some EMRs, I wonder if they think about doctors at all!) But ultimately, they’re going to have to decide whether they’re going to lead (create workflow patterns that follow, say, a care pathway) or do their best to provide a flexible, doctor-friendly interface.
I’d argue that EMRs should give doctors as many options as possible when it comes to using their system. Perhaps the system should shape their workflow, but only if the users vote, themselves, that such restrictions are necessary.
But the truth is that when a hospital spends a gazillion bucks on a system, they’re not doing it to win hearts and minds, no matter how much they may protest otherwise. And when a practice buys a system, they’re usually doing it to meet the demands of the industry, not give their colleagues their heart’s desire.
So let’s admit it. Though I don’t argue that they’ll ultimately be put to great uses in some cases, ultimately, EMRs are about dollars and bureaucratic face-saving. So, today’s workflow will just have to take a back seat.