The False Economies of EMR

In my recent look around the EMR twittersphere on EMR & EHR, I briefly commented on the challenges of choosing the wrong EMR and EMR Switching. Dan Haley from athenaHealth asked for some deeper clarification of my comment, “I’d say the biggest driver of EMR switching is thanks to the EHR incentive money and meaningful use.”

Here was my response:

I think there are a whole list of things in the HITECH act which encourage and promote the use of outdated technologies. I’m sure this is something you agree with and know all about as well.

My core argument has been, sure we’re seeing an increase in EHR adoption. However, what if the EHR incentive money is incentivizing doctors to adopt the wrong EHR. By wrong EHR I mean one that they don’t like, that can’t adapt to changing technology, that can’t support the future Smart EMR requirements that are bound to come, that kill a physician’s workflow, that cause a doctor to not want to be a doctor, etc.

I think we may be headed this direction and the number of doctors switching EHR software is a decent example of why this is the case. I’m sure that some would argue that meaningful use is driving people to switch EHR software and that the switch we’re seeing happening is from EHR software that isn’t highly functional to EHR software that is highly functional.

While this argument is true in some cases, there are just as many cases which illustrate that the EHR switching was because their first MU EHR was such a terrible experience that they had to switch EHR. Plus, we’re just at the start of this. Many are painfully grinding through the day to day with an EHR they hate. Wait until that explodes.

Even worse is those clinics that are switching EHR for the sake of EHR incentive money and go from an EHR they enjoy to one they hate. Add in the many doctors who are stuck using an EHR that was selected by some large company who didn’t worry too much about the physician needs and we’re in for a crazy next couple years.

Hopefully this gives you a better idea where my comment was coming from. Needless to say, I’m not sure that HITECH has been a benefit to doctors. The short term numbers might look good, but it might have just created some painful underlying difficulties going forward.

With all of this said, there are some beautiful EHRs out there that make doctors lives better. I’m pro-EHR when it’s done right. I just don’t see meaningful use and EHR incentive promoting the right EHR adoption methods.

This provided some interesting background for a conversation I had recently with a doctor. He told me, “It seems like there are a number of false economies driving EMR adoption.

I think meaningful use and EHR incentive money driving EHR adoption is a false economy. This doctor described to me how many of his colleagues weren’t using the EHR that they wanted, but instead were using an EHR that they “had” to use. What are some of the forced requirements for EHR that create these false economies besides meaningful use and EHR incentive money?

Another False EMR economy is around HIE connections. Many doctors can’t select the EHR they want to use and fits their workflows best because their local HIE may or may not choose to support a connection with that EHR. So, the doctor opts for an EHR that does connect with the local HIE even though it wasn’t their EHR choice.

Hospital Connections is another false economy. Similar to an HIE, many doctors will opt for what they consider to be a less than desirable EHR because it’s the one that works with their local hospitals.

I’m not trying to pretend that doctors should be the end all be all in EHR selection. A physician can think one EHR is the best and not realize until after using it that another EHR would have been better. Sometimes you think you have a great EHR until you actually use another one and realize what you’re missing. However, the easiest recipe for disaster with EHR is for a doctor to hate using an EHR. As I mention above, it will not end well and will drive the future EMR switching that I’ve predicted.

About the author

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

4 Comments

  • Once again, John, we are singing from the same songbook.

    It is insane to me – absolutely nuts – that in 2013 doctors need to worry about whether their IT, costing scads of $$$, is “able” to connect with the IT that other providers have also spent scads of $$$ to stand up. This speaks to the puzzling disconnect that we all countenance, for some reason, between our healthcare IT and the rest of our consumer experience. Put another way: most of us carry around these smart phones that we use to share immensely complex data, including video, literally around the world. We do this without a second thought, and never worry when we shoot off an email or a video file about whether our intended recipient’s own phone (or Mac, or PC, or whatever) will be “able” to receive it and respond. I can remember when communication between a PC and a Mac was a challenge, but that hurdle was cleared year ago. Yet for some reason when we go to the doctor, lean over the counter during check-in, and see the admin typing info into a system that was cutting edge during the first Clinton Administration, we just accept it. We live most of our IT lives in the cloud, yet hardly blink an eye at the fact that our docs mostly still use static software-based IT.

    And that goes back to the point that I think we both made under your earlier post: not only are providers still investing their own money in systems that are or soon will be obsolete (and that cannot communicate with each other); government, via subsidies, are keeping those systems alive.

    I recently attended a meeting of HIT CEOs hosted by ONC, shadowing my boss. It was illuminating.I posted about it here: http://www.athenahealth.com/blog/2012/12/12/back-to-the-future-of-ehr/

  • Speaking of false economies – most of the medical world (in the USA at least) is a false economy…but that’s a discussion for another day.
    =====
    Of course EHRs is/are a false economy. Anytime the G pays incentive money to someone, a false economy is created.

    If EHRs increased productivity/efficiency/[insert your metric here], docs would have been on them years ago.

    Poor choice of an EHR is 95% the docs fault. Most docs (wrongly) look at EHR selection like buying a new computer: they look at price, get tweaked on theoretical operational cost savings and if it is Meaningful Use compliant (this of course means nothing beyond Stage 1 right now).

    Add to this, most docs waited too long to give themselves time to really look, as they had to scramble to get their 90 day MU window tracked by year end.

    Then as consolidation occurs, or EHR companies just realize Stage 2/3/4 of MU just isn’t worth the cost, docs will be forced to switch EHRs against their will.

    There are surely others to blame in the process – just as my 15 year old lists reasons why he has to stay up all night to finish a paper, the simple truth is had this been taken seriously, things would have gone a lot better.

    @Dan
    I agree with what you are saying, but when the gov gets involved, creating a false economy, all logic goes out the door. Also, there has never been any incentive for an EHR vendor to connect their data to another…as…*gasp*…that might make switching to another EHR easier. It stinks, but is reality.
    After watching the bungling of our beloved government the last few weeks, does anyone honestly think they could have made this process any better? Once they get involved, things become ridiculous.

  • “Also, there has never been any incentive for an EHR vendor to connect their data to another…as…*gasp*…that might make switching to another EHR easier…”

    AMEN brother! That’s why one of the major initiatives we are pursuing in our DC advocacy is changes to existing law to allow for creation of a legitimate, functioning, two-sided market for Health Information Exchange. My boss blogged about that precise topic last week: http://www.athenahealth.com/blog/2012/12/20/all-i-want-for-christmas-is-my-two-sided-market/ The best part? The government wouldn’t need to spend a penny – just remove the legal/regulatory barriers to a rational, voluntary marketplace for exchange.

    As to the “might make switching to another EHR easier” thing, well, a vendor ought to have enough confidence in its services to clear that mental hurdle. Again directly on point (I swear I am not just looking for reasons to link-back) is number 1 on the HIT Code of Conduct that we proposed just today! http://www.athenahealth.com/blog/2013/01/04/athenahealth-new-year%E2%80%99s-resolutions-our-proposed-hit-code-of-conduct/

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