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?
-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.