I’ve had some interesting reactions to my post about the various characteristics of a Jabba the Hutt EHR Vendor. One of the more interesting conversations happened by email with a reader named Richard. Yes, I have lots of interesting back channel discussions.
After a lengthy email exchange, I asked Richard if I could post our discussion on the blog so you could participate as well. He agreed and even commented, “I look forward to an expansion of our discussion.” So, here you go (or at least scroll to the bottom for a short summary of my feelings).
The conversation started with this email that Richard sent me:
I understand your reluctance to name names in your article, BUT… this is exactly what is needed.
I’ve taken a few days to ruminate over what I was going to suggest and I’d like to hear your thoughts on this if you have time.
With your readership, I suspect there are plenty of users and observers of current packages and lots of opinions. Why not set up something like a Wiki-EMR site to provide a resource that will allow everyone to provide input into the details making “Jabba” and “Han Solo” EMR systems and see where it goes? Maybe it could eliminate some of the BS surrounding some of these systems and help others who are trying to sort out there own future needs. I’m sure there are plenty of people out there who want, need and are willing to provide information on the state and future of EMR and what is BS and what isn’t. I certainly would. Let me know your (or your readers) thoughts.
Here was my response:
Yes, this is something I’ve thought a lot about. The key question for me is how to publish some sort of “authenticated” information. Most systems are so easily gamed and/or abused that they basically have no worth. I haven’t figured out a scalable way to be able to provide information that is actual data and not provided with undue influence.
As I read your email, I wondered if some sort of combination of LinkedIn might be the key. At least then any review that’s done would be tied to an individual. Although, by doing so, you’d then discourage many of the most interesting reviews and feedback because their name would be explicitly tied to the review.
Along these same lines I’ve wondered how I could provide a “Meaningful EHR Certification” that wasn’t based on a pass/fail system that has no value. Instead it was a mixture of qualitative and quantitative data that would actually be of value to the reader. Scaling that up is the challenge I have with that idea. Not to mention figuring out the right financial model for it.
So, as you can see I’m with you on wanting more specific information out there, but not sure how to overcome the abuse and the scale that you need for it to be valuable.
Richard then provided this response:
It seems to me that user editing must be do-able if Wikipedia has found a way. Additionally, I think that unvarnished truth through comments creditable or not (but differentiateable ) would be a place for insiders or knowledgeable users and IT pros to vent. I realize that it is open to abuse, but a user moderated (or whatever Wikipedia uses) forum will turn upon such miscreants and their abuse might well backfire. I realize it is quite a project, but I’ll bet there are a handful of your readers, if not many more, that would gladly help put something this critical in place. If this can be pulled off, it might create “the world’s foremost authority” * in EMR.
I don’t know much at all about this, but I have a feeling that so much is riding on all of this and that there is a vacuum of useful, meaningful and understandable information that is needed to make this whole thing work. I know there must be something prescient sounding I could offer here, but it might be just indigestion that’s giving me this feeling. John, there must be some other smart guys around; try to round up some and see what they think.
Then I offered this response which shows I’ve been on Wikipedia far too much:
I’ve been rolling around something like this since I first started blogging about EMR. Wikipedia’s a bad comparison because it tries to formulate 1 truth instead of a series of opinions about something. Plus, Wikipedia relies on the masses of people (we don’t have enough mass) and even they get to a point where they regularly lock pages after abuse happens. Wikipedia’s a crazy community once you get into it. There are flame wars and battles on Wikipedia that rage in the background that most people don’t realize are happening.
Travel and hotel sites are a better comparison actually. Since reviews of hotels are more similar to a review of an EMR. The hotel owner wants to put the best reviews on there and can plant good reviews amongst many other ways to game the ratings and review systems. I read an interesting story about how Trip Advisor tried to deal with this. Unfortunately, it put on the image of successfully battling it, but didn’t do that well. Matters much less when you’re talking about a hotel versus an EMR.
I agree that it could become the authority on EMR software if it’s done right. Although, for me to do it, I have to find a model that’s authentic, honest, reliable, scalable and that makes sense economically. At least until I sell off a company for a few million. Then, maybe I can cut out the economical requirement.
Then Richard commented:
I didn’t realize that abuse was that rampant and that a fix was so difficult. I think I see some of the problems. You almost need a cadre of “fair witnesses” to explore the opinions and observations of users and provide incorruptible analysis. Not a promising outlook.
I’d be happy to assist this enterprise in any way I can, but don’t think I would bring anything very useful to the table. I feel you may be the right person to bring something like this to fruition, but the resources needed may be out of reach. It’s too bad there isn’t a Consumer Reports -like group out there for something like this. Maybe some group has enough vested in the outcome of shake-out to fund independent assessment and provide a forum for users.
I know very little about the technology involved in EMR, I am more aware of the medical business and needs for improvement in record and information management. Additionally, if cost containment can’t be managed and a “best practices” can’t be incorporated into every patient’s care then our society may be doomed economically (even morally). You’re doing something valuable, so keep it up, there must be a way to sort out the players and the technology so we can get on with the real need which is getting something useful and beneficial installed for quality patient care. Even getting this discussion broadened is worthwhile.
Well, there you go. If you made it through that, then you must really care about EHR and healthcare IT like I do.
In summary, I think it’s quite clear that it’s an incredible challenge for those searching for EHR software to find reliable information. The need for good EHR vendor information is extraordinary and no one has cornered that market…yet? There is no “consumer reports” for EHR software.
I haven’t yet identified a model that’s authentic, honest, reliable, scalable and that makes sense economically to deliver said “consumer reports for EHR software.” (or maybe I’m just too lazy, scared, busy, etc to try)
I do think that this site and the other members of the Healthcare Scene blog network provide a valuable independent resource for those selecting and implementing an EMR. My free EHR selection e-book was one effort to help providers in the EHR selection process in a very targeted way.
Are there other things that I (we) could do to help even more? I’m sure. If you have ideas, I’m interested to hear. You see my off the top of my head criteria above.
If nothing else, we can reach Richard’s goal of “broadening the discussion”