Real Hope for Broad EHR Adoption

I have a theory about the reason healthcare IT is so far behind many other industries. My theory on slow EHR adoption is that the tech savvy doctors have been stuck in school for so long and then stuck at the bottom of the totem poles in places where they can’t demand the use of an EHR.

My prediction is that a wave of technology savvy graduates will be the true change that will cause mass EHR adoption. As they become leaders in practices, they won’t stand for working in a paper chart deciphering illegible handwriting.

I believe this is the real hope for broad adoption of EHR software.

P.S. Seems fitting that I right about the real hope for EHR adoption on this the MLK holiday. Talk about a man who knew about real hope.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

14 Comments

  • 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.

  • Not buying it. I know too many old people in other industries that make extensive use of technology (they have to in order to compete). The problem is that most of the EMR software out there is not “high tech” – the young doctors aren’t going to like it either. IMO the “hope” is that new software is coming out every day and innovation will bring about useful EHR tools that are adopted.

  • 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.

  • It is only natural for people that grow up with certain technology to demand it where they go. It happens in every industry, students have years to learn and use tools that are available, and most of the time cutting edge. It is only natural for them to enter the workforce and try to bring those tools in, sooner than later.

  • 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.)

  • It remains that the sole HITECH benefactors are the EHR vendors and academic theoreticians who drafted the legislation and regulatory language.

  • 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.

  • Becky… let me guess. You work for a large health care software company? Please provide a full disclosure.

    What are the issues with electronic medical records when… ?

    “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…”

    What does the above or what you John speculated have to do with generational issues’?

    If your exgternal or internal client is not relating well to your application… perhaps it is the application that is the problem? Just a thought.

    (My full disclosure: 63yo male, professional, 40 years government and private sector business, MBA and graduate health services admin degrees. Led client-side groups as part of both DoD and private sector software development initiatives. Spouse: 30yr RN/FNP ICU, CCU, ED, now w/12 doc hi tech cardiology group, practice’s EHR implementation and training team. Son-in-law in fam medicine grp practice 6 years, EHR selection and implementation committee)

  • 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?

  • Glad I started a lively conversation. Too bad I did it on a Holiday when I wasn’t at my computer to respond. So, here we go.

    Oscar,
    Glad you agree. You’re right that it’s just going to be natural for them. That’s exactly why they’ll do it.

    Russ,
    Sure many older doctors use the software. In fact, there are many that are better at using it than younger people. However, too many of those older doctors are afraid of change. The mixture of fresh faces and a built in ability with technology is going to be huge.

    I do like your secondary hope though. I’ll be very interested to see what innovations in EMR could improve adoption as well.

    Don,
    Glad to see you agree with me too;-) lol Don’t misunderstand this post. I’m not disparaging older doctors that choose not to implement an EMR. I’m not disparaging anyone. I’ve just seen far too many “older” doctors (one doctor I met called them “traditional” doctors) not even evaluate the benefit of an EMR. Basically, they are fine with their current income, they’re fine with their paper files and they’re fine with not looking at ways to improve it. My prediction is that doctors who have grown up amidst technology won’t be fine with it and thus the increase in EMR adoption. I don’t see it as disparaging to make predictions like this without any hard data. You’re also welcome to disagree with my assessment. In fact, it’s quite interesting when people disagree with me.

    “I project that it will be very difficult for HITECH to succeed”
    Sadly, I agree with you on this, but has little to do with the age of the doctors I think. We’ll certainly be talking about this a lot more in the future. So, would you rather count on younger IT savvy doctors or HITECH act?

    Laura,
    I think the challenge with your perspective is that you’re talking about a hospital EMR. Actually, hospital EMR are quite customizable, but the phyisicans aren’t usually the ones that do the customizing. That’s done by some large IT/Clinical committee that makes decisions for the doctors. This isn’t as true in the ambulatory EMR setting where the doctor is often the one that tweaks all the various EMR settings. Certainly many EMR software isn’t as customizable as it should be and could be, but one of the biggest complaints most doctors have is that they don’t want to spend the time customizing it. Younger doctors that are use to customizing everything are likely more inclined to do these customizations. Even more reason they will adopt them more readily.

    Becky,
    I love your description of the challenge of paper chart versus designing an EMR. Add in that most are just glorified billing engines and we see the real problem with EMR design. Goes back to Russ Reese’s point about new innovative EMR software coming out to address this issue. The question I have is will our reimbursement process support this change? I like your concept so much, I’m thinking of discussing it in a future post (if I can ever fit it in amongst all the meaningful use chatter).

    Ok, time for bed. Interesting conversation.

  • 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

  • For a geeky take in laymans terms about oncology EMR, take a look at Ankhos.com . I think we have made some serious bounds in not being a “paper-replacement” EMR, but a high-powered productivity engine.

    It’s not just replacing paper the government is worried about, anyway. It’s the auditing, [dummy].

    Nick

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