What If Doctors Owned Part of Hospital EMRs?

After this many years of widespread use, you’d think that physicians would have accepted that EMRs are an inevitable part of practicing medicine — and at least sometimes, a useful tool that helps doctors manage their panel of patients more effectively.  But it seems some hospital administrators have concluded that a significant percentage of doctors loathe EMRs.

I draw this conclusion not from casual conversation with physicians, but from a hospital recruiting advertisement quoted in The New York Times.  The advertisement, which was attempting to attract doctors to a facility in Phoenix, closed its glowing description of state-of-the-art equipment and an attractive location with a single provocative line, all in bold: “No E.M.R.s.”

While EMRs are getting long in the tooth these days, they haven’t won over many doctors. As physician Robert Wachter notes in his NYT piece on the subject, a 2013 RAND survey found physicians most unhappy with EMRs, citing “poor usability, time-consuming data entry, needless alerts and poor work flows.”

I think it’s pretty obvious why EMRs continue to stay user-hostile. While doctors are the end users of  EMRs, hospital IT leaders and other CXOs make the final buying decisions. And he (or she) who writes the check makes the rules.

In theory, it’s strongly in hospital management’s interests to force EMR vendors to clean up their usability act.  After all, not only do hospital leaders want their EMRs used effectively, they want the data to be robust enough to be usable for value-based care delivery. But the truth is that hospital leaders are nowhere near demanding enough of EMR vendors. And because they’re the ones writing the checks, doctors get stuck with the ugly results.

But what if there was a way to involve both doctors and hospitals financially, as partners, in buying EMRs?  Not being the world’s greatest finance wizard, I don’t know how a hospital and a group of physicians could structure a deal that would allow them to jointly own the hospital’s EMR system. And I’m aware, though I don’t know how they would be addressed, that there could be significant legal issues to be resolved if the hospital was a not-for-profit entity.

But at least in theory, if doctors were paying for a percentage of the EMR, they’d have a lot more say as to what level of usability they’d demand, what features were most important to them, and what price they’d be willing to pay for the system. In other words, if doctors had skin in the game, it would put a great deal of pressure on vendors to make EMRs doctors actually liked.

Now, I realize that doctors might have no interest in buying into a technology which has let them down again and again. But there’s a chance that more visionary and tech-friendly physicians might grab the chance to have a substantial say in the EMR-buying process. The idea is worth a look.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

2 Comments

  • Many times the EMR’s are very flexible, and physicians do have some say in how the product is installed, however, they frequently do not understand or have the time until go-live when they actually have to use it to provide their input. After the go-live all the hospital teams are so “busy” they don’t have the resources to adjust the screens to support physician workflows. Those who are responsible for selecting the EMR have had a go-live date and the urgency to continue to modify disappears. Many physicians will say their reported issues seem to “fall on deaf ears” thus some of the dissatisfaction. Most hospitals do provide the ability for some physicians to have input in the purchasing of the EMR’s, however, as they say “the devil’s in the details” which no one sees until after the purchase.

  • IMHO, the author has clearly outlined the root cause of the problem – “hospital IT leaders and other CXOs make the final buying decisions.” It is entirely possible to involve physicians during every phase of EMR selection and deployement, but many institutions choose not to. The problem (and the solution) lies not with physicians, but with hospital leadership.

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