So, from the Department of Human Perversity, here’s my list of current EMR trends that don’t make a whole heck of a lot of sense. (I know, it’s easier to complain than to actually be out there fixing things, but hey, being a critic is what I do best!) In no particular order, here you have ’em:
* EMRs Are Expensive, But Free Ones Are Bad: OK, OK, before I have our friends at Practice Fusion on the horn telling me I’ve got it all wrong, yes, I realize that the free, Web-based EMR market has legs. But too many folks still seem convinced that TANSTAAFL (there ain’t no such thing as a free lunch). OK, I admit that sometimes TANSTAAFL does apply, but in this case, with free and cheap EMR options available, where’s the hard-line resistance coming from? For non-techies to be afraid of Linux — at least in its early days of commercialization — this, I get. But insisting on paying double for the privilege of getting an unwieldy system that’s a pain to upgrade? Not so much.
* Let’s Keep Our Paper Records Forever: So, as I’ve noted here before, some hospitals expect to store paper records for five years or more going forward, including some with mature EMR installationsin place. Keeping paper charts in play is certainly understandable from an emotional standpoint. Who wants to give up their way of life? And who knows what will happen if your EMR balks, gets junked and loses vendor support, displeases one of your key physicians, gets hit by a bus or…whatever (fill in your nightmare scenario). All sarcasm aside, this is obviously a very challenging transition. But if you’re going to go swimming, it helps to actually immerse yourself in the water. Besides, paper and electronic medical records largely aren’t compatible anyway, so what’s the point of maintaining both?
* If Our Templates Don’t Suit You, You Can Always Crawl Under A Rock: I’ll admit, I started out a bit skeptical that specialty EMRs were a big deal. After all, I reasoned, just how different would the underlying data structure and workflow for a cardiology and a psychiatry practice be? Actually, a lot, I’ve come to find out. In fact, I’ve come to realize that most EMRs aren’t flexible enough to suit two different medical practices within the same specialty. Sure, vendors offer customizable templates, but far too often, using them is so painful that staffers and doctors largely give up. That’s not only non-good, it’s dangerous, if it leads to clinicians working ineffectively. Now, I realize that enterprise software vendors in and outside of healthcare will force the customer to do the adapting if they can get away with it. But the big boys’ indifference seems particularly pointed in this case.
I have many other EMR industry pet peeves to share, but to my mind, these are having the biggest effect on the process of EMR adoption. So, do you think I’ve hit the real pain points? Do you have others to share?
My favorite thing is when someone emails Practice Fusion with the “TANSTAAFL” argument from a free Gmail account.
Well, there isn’t such a thing as a free lunch. Although, gmail and the likes get pretty close.
Definitely agree about need for different EMRs for use by specialists. We are seeing this with radiologists, for example. The system they need, especially when it comes to getting meaningful use bonuses and avoiding penalties, is different from most other specialties and certainly different from what a hospital would provide them.
The solution, I think, lies in a cloud-based, vendor-neutral EMR for ambulatory care, one that’s specialized for radiologists. The right cloud solution means they can easily aggregate work they do at several different facilities.
My concern with the EMR is that an EMR record can be umlocked and the record changed? Why is that allowed??
Lucy,
I don’t have a problem with it as long as the previously locked note and what is changed is fully auditable. As long as you know all the changes that are made and who made them and what was changed, then why not allow it?
The situation I describe above is better than a paper chart where stuff could just be written in later with no audit trail.