Apple EHR

@JohnSungKim @drtom_kareo I wish we could Apple-design the #EMR! #KareoChat Ability to customize every single deployed copy!

— Dino William Ramzi (@dwramzimdmph) December 10, 2015

I love how everyone thinks that Apple touching something will somehow make it better. Not only does this forget about the various times Apple has had product fails, but it also assumes that Apple can fix everything. It’s possible that’s what’s broken with EHR is the system and not the people creating the software itself. In fact, that’s what many innovators and startup entrepreneurs see when they look at healthcare and then choose to stay away.

I read a quote from a VC recently that said something similar to this, “When you go into a market you expect it to act in a certain way. Healthcare doesn’t act like a rational market.”

Chew on that concept a little. However, the final part of the above tweet is what really gets under my skin. “Ability to customize every single deployed copy!” People who ask for this don’t really know what they want and it’s also not fair to say that everything on the iPhone, for example, can by customized. Turns out that most people that get an iPhone or iPad do very little customization. The out of the box experience is really quite incredible with very little customization required.

We’ve written about this before back in 2010. Software vendors have to find the right balance between a beautifully simple and effective “out of the box” experience and the long term ability to customize the EHR in any form or fashion they desire.

I’m sure all the hospital CIOs reading this are shaking their heads when I talk about the “out of the box” experience being great. When they look at the millions (sometimes hundreds of millions or even billions) that they’ve spent on EHR consultants to configure and customize their EHR software, they could clearly argue that their hospital EHR has the “ability to customize every single deployed copy.” In fact, it costs them millions of dollars to get it customized. I’ve heard many hospital CIOs wonder why their EHR needs so much configuration. In the ambulatory world you can get much closer to an out of the box experience. Although, even they like to complain about there being too much EHR configuration.

This conversation is actually going to get even more complex. When you look at evidence based medicine and various care guidelines, there’s a movement to try and standardize some of the ways we practice medicine. I’m reminded of when I heard the CMIO of Intermountain say, “If we allow physicians to do whatever they want, we’re allowing them the right to take improper care of patients.” This is going to drive organizations to use a much more standards based workflow as opposed to their own unique customizations.

Finding the balance between infinitely customizable and hard coding proper workflows is an extremely hard problem to solve and will likely never be fully solved. However, it’s the challenge of any software system.

As far as Apple doing an EHR or as one person suggested, Apple buying an EHR vendor…that’s never going to happen. Just look at how simple their approach to Apple Health Kit has been. They’re not going to tackle the true problems of healthcare.

What I do think Dino was trying to say in the tweet above is “I wish I loved my EHR as much as I love my Apple products.” Now that’s a concept I can get behind and would be a great aspiration for every EHR vendor.