Monday, June 29, 2009

How Doctors feel about EMR vendors too much of the time...

I tried to post a specific Dilbert comic from last week, but the app seems to automatically move to the current cartoon. Fortunately, I think the text is all one needs...
Pointy-haired Boss: We can only afford to fix the high priority bugs
Dilbert: If we don’t fix 100% of the bugs, the software will be 100% useless
Dilbert: So our plan is to fail?
Pointy-haired Boss: More slowly.

Yep - I can't imagine any other executive in any other business putting up with the software physicians are expected to use: clunky, non-intuitive design backed by slow and error-prone technology. Would a bank VP be satisfied with software that required them to use 25 clicks and scrolls to find and document a single transaction? Would an air traffic controller settle for a system that only allowed them to view 1 airplane at a time and which "blew up" 3 times a day?

So why are we having such problems? Likely a combination of:
1. Not getting input from "true" users (do we think the people who created air traffic control software just designed it in-house and then sold it "as is"?).
2. A poorly aligned reimbursement system which provides minimal reason for doctors to use these systems. The potential meaningful use bonus, we be a start - but we still need a more comprehensive reimbursement adjustment to reward efficiency and quality.
3. Lack of standards: I hate to say it, but we are part of our own problem - every time we allow multiple EMR vendors on the same campus or over-customize the software we buy, we make it harder for there to be consistency over time. I think we really need to look at models where there is some consistent framework across the nation, and then there is the ability to add on feature/apps as an option- the "iPhone" model. Examples might include ATM machines, law databases, and again- the air traffic control software (but I'm not sure- feel free to enlighten me).

Finally, there was a recent article which suggested the real problem with EMR adoption is that medical providers are worried that EMRs will "reveal" too many financial secrets- wow, that guy was out of touch. Most docs would love a good system - but it has to be really helfpul to their daily lives. How would that writer like it if his Word processing software required him to click on 5 things to get a capital letter, and 6 to start a new paragraph? And what if he could get paid more for handwriting his columns because it was faster for him?

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