Real Hope for Broad EHR Adoption

Hi John, I think your prediction is right on the money. When more young people enter the industry, after having high-tech throughout their lives, it is only naturally that they’re going to bring that into their work.

John… Like a lot of things you write … but your post and Oscar’s comment are full of baloney.

You’ve said it before that practices should adopt EHR if it makes good business and clinical sense for the practice. You made a point that ARAA incentives should not be the reason why practicies adopt EHRs. That’s exactly what physicians or practice owners are doing … they are considering how an EHR contributes to their business case and clinical quality. If there were positive reasons that show EHR contribution in those areas … then why wouldn’t they have already made a commitment?

This has absolutely, positively nothing to do with older docs or younger docs. To make that assessment without the data to support it is not only disparaging to those decision makers … but if your perspective is held by many techies and government interns … then I project that it will be very difficult for HITECH to succeed.

If EHR made such great business sense and improve national health care quality … then how come the government isn’t funding implementation of the standard government system in each practice? Surely the govenment knows what is best. Least wise that’s what the politicians all say.

By the way… how is the government doing to develop all the regional info exchanges that those practices who have implemented EHRs could be plugged into right now but aren’t?

The HITECH initiative has so very little chance of success. Counting on younger docs is laughable, disparaging, and naive.

I agree that it is natural for people who were brought up with technology to demand that it be able to be integrated into their day-to-day work regardless of what they are doing (including medicine). But I’m in agreement with Russ Reese that the young doctors don’t like it either.

I’m middle-aged but tech savvy with degrees and lots of experience in computing. I’ve watched what has happened as our teaching hospital has rolled out its multimulti-million dollar electronic record. It does have some benefits but unfortunately it also has so many glitches and usability gaps that it’s difficult for the non-tech savvy to learn and frustrating for the tech savvy physicians who are used to using much better products in every other aspect of their technological lives. (From what I can tell, the problems with our system are fairly comparable to the other commercially available software products.)

Tech savvy users are also accustomed to being able to get high quality software at reasonable prices or even for free. They are also accustomed to being able to adjust their program’s features to their unique needs (with browser add-ons being just one popular example). Most electronic record software is just not set up to do that degree of customization at the end user level.

So even though I’m one of the first to try a new technologically sophisticated piece of software in other realms, if I were in private practice, I’d wait a whole lot longer before investing in an electronic record system. (The incentive money isn’t going to be nearly worth the hassles and potential horrors of early adoption.)

I agree that a large part of the industry’s slow adoption of technology is generational. After working with hundreds of doctors and thousands of nurses, the clear (and admittedly generalized) magic line is the age of 40. Those over are less interested or willing to become more technical. Those under are, by the numbers, more open to the whole idea which makes them more capable users. Before anyone becomes enraged – there are exceptions to every rule – this is generalized from thousands of interactions in needs analysis, development, training and support.

The second contributing factor is design. EMR vendors have included providers, nurses, and ancillary staff in designing their product. In an attempt to placate users who are used to paper charting, vendors are still creating a paper-mindset for the computer. An EMR is not a paper chart on the computer screen and as long as users think that way, complain when it doesn’t work that way, and vendors design that way… there will be issues with electronic medical records.

Nope. I worked for a 340 bed hospital and now a 24 bed hospital, never for a software vendor of any industry. 38 yo, BS in MIS, IT Analyst, Systems Support Analyst, 7 years in healthcare, 7 years in academia, 1 year in manufacturing.

The distinction I was trying to make boils down to this – paper charting is static and a well designed EMR should be dynamic with strong reporting/extracting/interfacing capabilities. So much of the two major EMRs I have worked with are closer to static than dynamic – partly due to evolving functionality (the vendor) and partly due to weak leadership and staff/provider resistance. Whenever we do needs analysis, users get mired in details from a paper charting perspective. When we look at workflows, there is great resistance to change anything, even if it’s provably more efficient. The people providing the greatest amount of resistance are older, again generally over 40 (and there are exceptions as I said in my first post).

I was/am a coworker in the thousands of interactions I am basing my perspective upon. My job was/is to help my coworkers do an important part of their job more thoroughly, efficiently, and effectively. It was easier for a caregiver to write everything they ever wanted to say in a note. It’s more useful across all disciplines for information to be categorized logically so it can be disseminated and acted upon as appropriate.

I have no empirical studies, I said my perspective is based on thousands of anecdotes. It is generally accepted that the longer any human does something, the more rigid he or she becomes in doing that something. So Don, how are you so sure there is no generational components to acceptance of EMR’s?

Whatever happened to the adage; “If it ain’t stinking don’t stir it” ?

I believe that EMR adoption is more about social engineering. We want traditional users coming from manual paper jump to a highly technical new era of computing. It’s like asking them to make a change when what they know already works and where they will change to has some risk.

If only software developers can design EMR/PMS in such a way that practitioners can wet their feet a little bit, upon which they will be suckered onto computerization (because they will see the benefits and they will like going forward). The problem is most software designers think geeky and could not talk the layman’s language.

JP