Random Thoughts: EMR Projects Decentralized; Problems Persist Despite ‘Solutions’

Once in a while, I run out of Big Ideas to share and resort to a rundown of short items. This is one of those times. Often, though, that approach turns out to be more interesting than a well-thought-out commentary. (Thus, the popularity of Twitter, right?)

Speaking of Big Ideas, I’m thinking that the age of the massive EMR project may be coming to an end. You may have seen my piece in InformationWeek today about the reported end of the national EMR in England. London’s The Independent reported earlier this week that the Cameron government will announce next month that it will scrap the national strategy in favor of allowing local hospitals and trusts to make independent EMR purchasing and implementation decisions.

This news comes on the heels of a decision by the government of Ontario to give up on hopes for a single EMR for all of Canada’s most populous province.

On the other hand, here in the States, we’ve seen a lot of consolidation among healthcare providers, but I’m guessing that has more to do with administrative Accountable Care Organizations and the prospect of bundled payments than any desire to build a more unified EMR. Though, consolidation does make health information exchange somewhat easier, and that’s going to be key to earning “meaningful use” dollars beyond 2013.

On a somewhat similar note, doesn’t a headline like, “Positive Outlook for Small Practice EHR Adoption” sound like a no-brainer? I mean, isn’t that the segment of healthcare providers that historically has had the slowest adoption rates? More than anyone else, small practices—particularly small, primary care practices—are the intended target of the federal EHR incentive program. And most of the news from health IT vendors of late has been about how they are going after this long-neglected market, right? The innovation seems to be happening in ambulatory EMRs, as evidenced by DrChrono’s newly certified iPad EHR app, aimed squarely at independent physicians.

That said, vendors and publicists, please do not start inundating me with news about other EHRs getting certified. There are hundreds of certified products out there now, and I cannot and will not write about, oh, about 95 percent of them.

While you’re at it, please stop using the word “solution” as a synonym for “product” or “service.” Tech journalists hate this trite, lazy and, frankly, inaccurate term so much that I’ve been instructed by the editors of InformationWeek not to use it, except in direct quotes. In fact, I get reminded not to use it pretty much every time I’m forwarded a press release laden with news about someone’s “solution.” Solution to what? I’ve been seeing that term since I started covering health IT more than a decade ago, and I still don’t see much getting solved in healthcare. With all the “solutions” out there, you’d think that healthcare had been fixed by now.

I could get a whole lot more curmudgeonly on you, but I think I’ll stop now and await your comments.


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Neil Versel

Neil Versel


  • John… Sharing the content of my post to the Indepenant’s story:

    “My American view is one of irony as U.S. administration’s healthcare officials continue to worship NHS and UK’s centralized IT vision.

    The failure here is the failure at the secondary care level and higher. What is working well is the success by EMIS and a handful of other health IT companies to privately accomplish in developing a strong integrated decentralized networks at the primary care level throughout the UK.

    Lesson … centralized systems fail due to size and lack of focused requirements and weak unelected bureaucratic leadership. Local systems guided by the accountable leaders at the trust- and institution-level with constrained funding and focused requirements yield results.”

    I wonder what Donald Berwick’s response would be to the news from the UK?

    The Independent story documents failures of IT programs from across the entirety of the central government … not just NHS … so the failures are apparent in national central vision regardless of domain and function.

    THAT … is a very important point that we here need to recognize.

    Oh and the 11.4billion UK pounds equals $18.7billion. Now where have we seen that number before?

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