EMR Ethical Dilemma

I was really intrigued by this well done article by Dr. Richard Hom about the Ethical Dilemma of the EMR. In it he describes the difference between the EMR technology world that will “sell anything at any cost” against the medical community values of things like the Hippocratic Oath.

He ends the post with these stinging paragraphs:

But medical angst persists. Because the EMR vendor is pursuing a “top down” sell, they bypass the medical leadership and pitch the C-level administrative staff. The medical input is usually an afterthought and the medical angst continues.

Countering the medical angst and overcoming the perception of “business ethics” being ugly will not be easy. If there be a truth in medicine, it is the gaining and loss of trust. Trust is not a trivial matter that can be bandied about just for a sale. To belie the image of the untrustworthy EMR vendor, both vendors and medical professional must make this their primary goal and objective even before the first sales pitch is given. The reward is either an EMR project that is successful after two years or an unsuccessful project that lasted ten years. The shipwrecks of EMR failed projects are a testament to that result should we forget this difference in world perceptions.

I agree that trust is really the key to a successful long term relationship with a doctor’s office. The sad part is that far too many EMR vendors aren’t interested in the long term relationship. They’re making the quick sale and then looking for the next sale. I really believe that a number of EMR companies are going to quickly scale to a level of sales where they can’t support the growth and then sale off to another competitor.

However, more important might be those EMR vendors who go in for the quick sale and then leave the clinics hanging during the EMR implementation process. You all know stories of what I’m talking about. I suggest that it’s only going to get worse not better.

Add in the EMR stimulus money and the natural increase in initial (at least) EMR adoption that will occur and even many well intentioned EMR companies are going to be caught in the trap of trying to support all these EMR installs. Lack of support from the EMR vendor is going to lead to even more EMR failures.

Naturally, all of these increased EMR implementation failures will taint the EMR industry even more and slow EMR adoption worse than ever.

Not to be all doom and gloom. I’m just highlighting one possibility. What’s the solution?

1. EMR vendors don’t over sale (this will be nearly impossible and takes a special vendor to not do this).
2. Doctors, do more research about the EMR vendor you select. I call it an EMR vendor background check.

EMR is the future, but the question is how long until that future is the present.

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.


  • When I put myself in the shoes of a Doc who has yet to buy an EMR… yikes! So many choices, everybody has the “right” solution. Most say they are already “certified” to achieve Meaningful Use, yet the Doc is told the criteria isn’t even established yet. I can’t imagine the frustration of shopping. You can listen to a salesperson all day long, but in the end the best research is to narrow it down to a few EMR’s and start finding sites using that product live. Research is key, but in the end you need some real Docs to give some input.

  • Some pretty strong stereotypes going on here! The evil vendor Vs the honest and true Medical Practice……

    While the perennial distrust in the market is unlikely to dissipate anytime soon, there is an alternative to having to place all your trust in the EMR vendor.

    Partnering with a Technology consulting firm could be the solution for a practice to achieve a better EMR outcome. (Consulting being the operative word here)

    I would respectfully suggest that a medical practice moving from a paper based process to EMR is not best positioned to make decisions around technology investments that will become the backbone of their business.

    I wouldn’t perform surgery or be confident in diagnoses even with prolonged and in depth internet research. I would go to an expert – a trained, professional doctor that I trust. Why should it be different for the field of technology?

    A “trusted” IT partner that works for the practice and its interests might be the solution to keep vendors honest in a dishonest (perceived) market.

    While some may believe this to be a vehicle for adding an additional layer of expense to the process. I would argue that the right partner will help the implementation immeasurably and save the project time and money and deliver a more robust solution – a solution that fits the needs of the practice rather than the practice fitting the technology.

    To echo Brad’s comments: As with any IT implementation, the hard work gets done before the hardware and software goes in. The more time you spend mapping processes, gathering input from stakeholders, and thinking about the transition to working in an electronic environment, the more successful the implementation and ongoing adoption will be.


  • Gavin,
    I never said the EMR vendors were evil. I did suggest they are capitalists. I’ll let you decide if that’s evil or not.

    I think partnering with a technology firm is a good idea. At least for the tech part of the implementation. I don’t think it’s a great idea for the EMR selection part of the implementation. They are tech people. They aren’t EMR selection specialists.

    I liked how one IT firm that I respect described how they are happy to offer their technical perspective on the various EMR, but that they couldn’t offer anything beyond that. They just don’t know how usable the EMR system is or how well it would work in a GYN versus a dermatologist.

    Some IT firms know one EMR quite well. So, I’m fine with doctors who selected their EMR through some outside process then utilize the EMR implementation skill of the IT vendor. That can make a lot of sense.

  • I guess humor didn’t come over so well in my comment – purely meant “tongue in cheek”. ;0)

    I think you are correct, the vast majority of IT firms are purely “techies” and selection of an EMR has to be done by the practice and the people that use it.

    I agree It would be unwise to suggest that an external support organization make that decision. I guess it comes down to if you have a partner looking out for the best interests of the practice or an IT firm trying to sell hardware….If you have a partner, it makes sense (for me at least) to have a technology perspective in the selection process.

  • Gavin,

    Having been on several RFP committees, I can say that this phenomenon is not diminishing, rather it is increasing. It is only after the sale can or do vendors start to placate the medical community.

    Smaller vendor houses are employing the bottom up approach but only because they know they cannot expend the resources necessary to achieve a top down sales.

    Having also been in the sales process, i can tell you that any vendor or consultant wants a top down approach and no vendor wants a quick sale. Everyone wants repeat business, especially consulting business.

    Here is the quandary. If a vendor plays to the communities before the sale, everyone from the vendor to the consultant has to recapture the profitability somehow.

    In the past, the consulting houses would pitch deals with the big partners and then let loose green inexperienced junior consultants to hone their skills. The clients were the experimental and teaching opportunity.

    This hasn’t changed, even though an agreement will stipulate it.

    Has the economy changed this? Of course, but again, all players on the sell side from the vendor to the consultant has to make money somewhere. They just cannot continue to give the time and money away.

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