The Perfect EMR is Mythology

I don’t know about the rest of you, but ever since David Blumenthal left ONC he’s had plenty of interesting things to say. I think he’s still somewhat cautious, but you can tell he’s given himself more freedom to comment on the state of EHR software and how it could be improved.

One example of this was in Andy Oram’s writeup of David Blumenthal’s speech in Boston a little while back. Here’s one section of Andy’s write up that really hit me (emphasis mine):

Perhaps Blumenthal’s enthusiasm for putting electronic records in place and seek interoperability later may reflect a larger pragmatism he brought up several times yesterday. He praised the state of EHRs (pushing back against members of the audience with stories to tell of alienated patients and doctors quitting the field in frustration), pointing to a recent literature survey where 92% of studies found improved outcomes in patient care, cost control, or user satisfaction. And he said we would always be dissatisfied with EHRs because we compare them to some abstract ideal

I don’t think his assurances or the literature survey can assuage everyone’s complaints. But his point that we should compare EHRs to paper is a good one. Several people pointed out that before EHRs, doctors simply lacked basic information when making decisions, such as what labs and scans the patient had a few months ago, or even what diagnosis a specialist had rendered. How can you complain that EHRs slow down workflow? Before EHRs there often was no workflow! Many critical decisions were stabs in the dark.

Lots of interesting discussion points there, but the one I take away from it is that there’s no such thing as the perfect EMR. Blumenthal is dead on that many doctors have this abstract ideal of what an EMR should be and it will never be that way. Certainly there are benefits to implementing an EMR, but there are also some challenges to using an EMR as well. No amount of programming and design are going to ever change that.

I wish I could find a description I read 4-5 years ago from an EHR vendor talking about the doctors they liked to work with. In it they described that they liked working with doctors who had reasonable expectations of the EHR implementation. They wanted to work with doctors who wanted to go electronic. They wanted to work with clinics that understood that some change was required as part of any IT implementation. From what I can tell, that EHR vendor has basically done just that.

Reminds me of trying to force my kids to do something they don’t want to do. Never seems to end well. Instead, it’s a much more satisfying experience for all when I help them understand why we’re doing what we’re doing. They still don’t like some of the details in many cases, but at least they understand the purpose for what we’re doing.

As long as doctors cling to some abstract ideal of EMR perfection, no EMR vendor will ever be able to satisfy them. A perfect EMR is not reasonable. Just because an EMR doesn’t offer everything that you could dream, doesn’t mean it’s not an incremental improvement over what you’re doing today.

Don’t let the quest for perfection get in the way of incremental improvement. Perfection is more nearly obtained through many incremental improvement than giant leaps.

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.

8 Comments

  • Great article. It really hits home for me as I’ve been saying the exact same thing for about 10 years now. In my experience, the number one issue with adoption can be directly attributed to not setting the right expectations from the beginning. of course, there’s a lot more behind that statement, but I think you get the point. You’re absolutely correct, “as long as doctors cling to some abstract ideal of EMR perfection, no EMR vendor will ever be able to satisfy them”. Yet, on a brighter note, I have seen the future. I found my one year old daughter the other day playing with my iphone. My first reaction as a parent was to quickly take it away from her, but I found myself being mesmerized by her innate ability to navigate the touch screen. It was almost second nature to her. I watched for several minutes as she swiped her finger across the touch screen to find the photo app.. She then opened her favorite photo of herself. It was a photo of her sitting in a laundry basket on our kitchen floor, smiling at the camera while our golden lab, Lily, licked her face. At first I thought to myself this whole navigation thing she was doing with my phone was a fluk, right? How could she possibly know what she’s doing? She’s only 19 months old for crying out loud. My mind was racing, just then, she raised her head and looked at me, held up the iphone so I could see the screen. She then pinched her fingers together on the screen and slid them apart and zoomed in on the photo, and she said, “doggy”.

    I have seen the future, and it’s looking mighty good from where I’m sitting. Now I just have to figure out how to pay for her med school!!

  • Agree with your point, but the reality, as Zach said, is that we are now comparing EMR to our iPhone 4s’s. Our consumer technology is so far ahead of hospital technology that it is jarring and annoying to use work tech. This is what I want: “Siri, give me a differential for elevated amylase. Thank you. Now order CBC, Chem 14, TSH and free T4. Good. Now I will dictate. The patient is a 41 year old man with abdominal pain…”

  • Thanks for sharing Zach and good luck paying for med school. Of course, that’s a topic for another discussion.

    Brian,
    That comment is going to make for an interesting post. I wonder how many doctors use Siri for medical stuff.

  • I wish people would not forget that electronic health records systems existed long, long before they became popular due to meaningful use and government support. It’s just that they were not as popularized or interconnected, and there were a lot less of them back then than there are now. Now we have a marketplace exploding with options.

    For that matter, here’s a fun challenge: try to find an example of at least one paper-based charting system or method (including faxing/photocopying/phone calls as part of the system) that works as well as a modern EHR. There must have been or be at least one.. I mean, health care has been practiced for all these years and not all of it was totally terrible without EHR.

    It’s ironic that as a technologist, I find myself wanting to point things like this out, and I’m far from a luddite to be sure. We can see the benefits (and potential benefits) of technology. But it is so easy to be blinded by “unlimited” potential, so as to forget the past and ignore the obvious.

    Regarding “incremental improvement” – W. Edwards Deming offered us TQM (total quality management) and the “continuous improvement” movement through the plan-do-check-act cycle, for example. We have learned more about this through things like the japanese Kaizen model. This is a well documented and proven discipline.

    A relevant word of caution, though – incremental improvement *without discipline* can be dangerous. For example, incrementally adding features to any type of system without any direction, poor integration, or no logical requirement to do so can lead to fragmented, broken, buggy or just plain annoying systems. There has to be a balance between need, price, quality, and speed.

  • Blumenthol and ONC in general have been doing some great work which generally goes un-appreciated; incremental improvements and added functionalities will be the order of the day for few years to come. We are getting there.

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