Speaking about government financial incentives to help healthcare organizations acquire Electronic Medical Records, EMR, evokes a lot of passion. Social media, blogs, online magazines, hard copy – the comments range from full support to total rejection of government being involved in any such efforts.
The focus of this post is the particular argument that Federal EMR incentives has led to dissatisfaction and debacle. Personally, I can see how “Meaningful Use” may have been the hand that fed an organization's bad acquisition or deployment decision. However, I do not believe that government structured the program that made a bad decision the default outcome. If physicians are not happy with the product selected, is that the government’s fault? Or is that the result of a poor acquisition and or deployment strategy?
I look forward to your comments.
There are two major unnecessary technical flaws in the current crop or EHRs:
ReplyDelete1) Horrible UIs which turn doctors into key punch operators and make it very difficult and time consuming to retrieve information in them.
2) Extremely poor architecturally (i.e. Microsoft Windows .Net based), which creates all sorts of data security issues and an inability for elegant, standardized interoperability.
The solution is a complete replacement of EHRs with a much more productive paradigm for clinical data capture and retrieval using the same application architecture used for decades in other industries.
Hard to find a signal place to point fingers on how we ended up with this mess, but the solution is easy. Healthcare needs to bring in IT pros from other industries that have the experience designing, building and implementing complex applications incorporating modern technology (this is NOT Windows - even Microsoft is scrapping the Windows paradigm with its Metro interface in an attempt to catch up to the current state of the art).
Healthcare simply does not have the technical, systems, financial or operational IT experience to go it alone (with a few rare exceptions).
EHRs are so 1980s it isn't funny. Break out the disco ball, bell bottoms, and paisley shirts.
EHR, some MMIS, and Financial platforms as well... 1980s. Your comment on the 80s reads the same as a line right out my book. Thanks
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Delete"1) Horrible UIs.... and 2) Extremely poor architecturally...."
DeleteHave you seen any improvements over the past year?
Submitted by Ron Troy, MBA, FIA through e-mail
ReplyDeleteIMHO, MU may drive a decision to migrate to an EHR, and you usually have to pick from an existing EHR, but it does not drive you specifically to pick a bad one, or one that does not work for you. Bad decisions come from poor choice, from not enough studying of one's own needs, examination of what is out there, putting enough effort into needed customizations, bad training and support and more of the like.
I don't mind government driving the move to EHRs. Where they don't, eventually insurance companies will. I do wish that right now it wasn't just for CMS paid patients, though. That's beyond absurd. And government paper pushers plus educators making decisions for hospitals and practices leads to requirements that don't always make much sense. And it does skew what people look for in an EHR away from what they need to improve patient care in some cases towards one that meets MU requirements.
Beyond that, there are obstacles to making a good decision. There is no complete comparison chart of all the viable products that I'm aware of; even one you can pay for only covers ones that pay to be in it. This is a huge mistake by ONC, IMO. There is no clear path to adoption. You realize you need one. You go to a demo at another practice or hospital, but who knows how complete a picture you get. You pick the 'IBM' of the EHR world (or rather they pick you), or you pick one you know nothing about, or haven't heard too much bad about.
I have a relative, an optometrist, who is using a specialized EHR for his field, designed by a friend, that is cloud based. Not cheap, but at least appropriate. He doesn't get much MU money simply because of his patient mix, even though the EHR and his use of it meets MU requirements (easily). And that points out another issue; MU money excludes so many practices that could otherwise benefit but which can't afford it. And MU completely ignores some of the real benefits, such as the ability to do long term tracking of a patient's illness versus various medications.
Ron
"obstacles to making a good decision- no complete comparison chart of all the viable products that I'm aware of" would need to be built by consultants with deep experience --perhaps by Accenture. However, typically, the results of comparisons made to determine purchase are held as secret and proprietary to the client/engagement.
ReplyDeleteI agree, MU misses many practices, and longitudinal studies; heretofore almost impossible are key to the patient's best interests. Cloud architecture was a dream when EHR's were structured, but security would be primary question.
Thanks for your reply. Great points.
DeleteCan you point to a specific specification from Phase 1 and how that led to unobtainable requirements?