In any industry, there will be a certain percentage of those working in it who can’t move with the times.
New technologies, in particular, jolt people out of their usual ways of doing things, and leave those who don’t adapt in the dustbin. (Your classic “unemployed buggy-whip maker” comes to mind.)
The current narrative suggests that doctors who won’t buy in to the EMR movement are buggy-whip makers, too. They’re, let me see now, uncooperative, stubborn, inflexible, timid, recalcitrant, defiant…got any more? Clearly, any doctor who’s being dragged kicking and screaming into digital medicine is an old fogey or an arrogant type who deserves to be put into their place. Right?
Not so right. The reality is, the shift from paper to EMR-based practice isn’t just a phase-in of a new technology, it’s a movement into a whole new world. And it’s a place where the rules may turn out to be completely different than those doctors live with today.
While the post-EMR world may offer big clinical improvements, financial savings, improved safety and more, it’s likely to induce painful changes in the way doctors conduct their everyday work.
I’m not just talking about short-term workflow adjustments, I’m talking about introducing a new way of life, one which asks doctors to serve as clinical data analyst, sophisticated software user, expert on health data sharing and more in addition to providing direct care.
Ok, now you’re thinking that I’m exaggerating wildly — that most doctors will just need to go through an EMR training period, figure out where to click and get some practice doing it efficiently. Problem solved.
But I beg to differ. If that were all the government wanted doctors to get out of EMRs —- the ability to competently assemble an electronic patient record — I doubt the feds would be creating Meaningful Use standards and paying incentives. Doctors aren’t just being asked to use new systems, or even just to move from paper to software, they’re being asked to rethink the role they play in care delivery overall.
Let’s face it, we’re not just talking about switching from the typewriter to the computer.
We’re looking at a revolution which will, over time:
* Turn even single-physician practices into a node in a vast health information exchange
* Require doctors to pick up a wide variety of analytical/IT skills which may, on their surface, have little to do with traditional office-based medicine
* Permanently change the way doctors evaluate, diagnose, comunicate with, counsel and manage patients
Now, if the EMR revolution even comes close to meeting its patient safety, quality improvement and efficiency goals, I doubt doctors will regret the changes they had to make. After all, most doctors are incredibly dedicated, hardworking people who would be thrilled to find ways to improve their patients’ health.
In the mean time, though, I’d love to see critics tone tone down the anti-doctor rhetoric and think about what’s really going on here. If we treat doctors like the intelligent adults they are, and collaborate with them, they’ll befriend health IT tools like the EMR in good time. If you treat doctors like they’re the problem, forget it.
Post-EMR?
Thanks for the comment — I probably should have said something like “post EMR adoption” world. What I was trying to say was that once the painful EMR adoption/transformation process is over, they’ll just be part of the fabric of the industry. We’ll be “post-EMR” in much the same way that we no longer have learned conferences on whether we should use the Internet. (I remember participating in a tradeshow called “Internet World” in 1995 — and at the time that made sense — but doesn’t that sound strange today?)
In that brave new world, it will be such a given that doctors use EMRs that the mere fact of their installation won’t even be worth discussion. Everyone will be working on how to handle higher-order clinical data management problems.
I was just thinking out loud, playing at a bit of word association (postwar, post-colonial, postmortem, postnatal, postprandial), thinking about “post-EMR”’s connotation. Years ago I used to conduct an informal survey in which I asked “What comes after the EMR?” Answers usually involved EMR data (exemplified by today’s EMR business intelligence activity). Today, however, if one asked “What will the post-EMR world look like?” I wonder what other themes might emerge. Nice post. Made me think.
Still waiting for big clinical improvements, financial savings, improved safety and more.