Yesterday, on a blog at Healthcare Informatics, Suresh Gunasekaran discussed his "Top 11" reasons why EMRs are Overrated. He discussed the need to consider how an EMR would be used in order to obtain its desired benefits.
Here are his Top 11 Reasons ( with my commentary ):
1. Can't Get Information Out. This author discusses the need to have a cogent aggregation of clinical healthcare information in order to use it for the patient's benefit. I agree. It's not enough that information can be collected in an electronic format. Management of knowledge (a.k.a. Knowledge Management in other industries) considers how it will be used to answer questions, make decisions, and improve patient outcomes. Knowledge Management is secondary to the actual EHR implementation, but is of high importance for sustaining benefit from this enabling technology.
2. Computers Don't Change People. Well, I might add here that I really don't think anyone or anything can change people. People have to change people - we must have the desire to change our thinking and our actions. The point here is that even though healthcare professionals have a computer that contains important information that is used in the clinical setting, we still must have the necessary communications with others in a collaborative fashion to affect outcomes.
3. Not Enough Patient Participation. I believe this statement points to the patient's use of PHRs. I believe that a knowledgeable patient will invest the time to learn how to use a PHR if they have access and assistance. There are "free" PHR services for the general population, but from my own experimentation, the only independently usable links are to commercial drug stores. Physicians, diagnostic labs, hospitals, and other providers need to establish a secure way to provide patients with the data they want to collect. This may take a while.
4. The Data is Ugly. Not sure that it is really ugly...we really haven't seen much data since only a small percentage of providers are on EHRs. Perhaps what this means is that (see #3 above) we need a common standard that enables secure information exchange. There is significant effort in the industry related to HIE standards. Healthcare is still in its infancy with respect to interoperability - we have to get the data IN before we can exchange it with others.
5. We Don't Know How To Drive. The larger point, beyond the user interface, is the fact that many healthcare providers are from the generation of paper-based records. Just like we moved from the Agricultural Age to the Industrial Age, we are now in the Information Age - soon moving to the "Communication Age" with social networking tools such as LinkedIn, Twitter and others.
6. It Doesn't Know Me & Can't Listen. Yeah, computers are dumb, so we have to make up for that inept "box" and put our "thinking caps" on and make sense of its message.
7. They Don't Help You Drive Clinical Quality. This author proposes that additional technical innovation is required to improve clinical quality. I disagree. Technology is not the solution - it's a tool. E-Prescribing might be a move in the right direction, but it still requires that providers and healthcare professionals put thought into every interaction with the clinical record.
For example...when I signed up for my PHR and I connected to my pharmacy to import my prescription history, I saw a prescription I never received from my providers and had never purchased. So what did I do? I deleted it and called the pharmacy to tell them that this prescription was in error. Interestingly, when I signed my husband up for his PHR and imported his prescriptions, the same incorrect prescription appeared.
The moral of this story? Don't believe everything you see or read. Question it, confirm its validity, and correct it before you use it.
8. It's too expensive. While it is true that EHRs can be expensive, almost every technology when it is introduced to the market, bears a premium. Over time, as it matures, the price-point should become more stable. However, the cost to sustain the investment, if not managed efficiently, has the potential to skyrocket. Note here: engage multi-disciplinary staff to help manage the EHR investment and learn from the mistakes made in other industries.
9. We need new staff. I think we just need to train staff on the proper use of the technology. With a good educational program we can learn. People are smart, computers are dumb. Remember that it is not only education on the use of technology, but also education needed to affect the associated culture change necessary for its use.
10. EMRs don't make money. They are computers. People make money. The key here is that goals should be set that support the ROI of EMR investment. It's not enough to say that the goal is improved patient outcomes, although that is a key benefit and goal, but consideration into how the EMR is used to reduce inefficiencies and costs will improve profit margins, thereby making money.
11. Clinical Research. Given the confidentiality of patient information, providing EMR data to others may be a violation of HIPPA rules. However, providers might consider using their de-identified EMR data to evaluate their own progress in meeting established goals, in learning from their patient's conditions, and maybe become smarter by doing so.