Thursday, August 21, 2008

EMR Adoption in Small Practices

Why all the resistance and difficulty in getting EMR's adopted and in use across the board. Why is there not a queue along the street as there was for the Apple iPhone v1 and v2?

Is it the usability, the coolness, price point, ROI, design and features, overall complexity or just basic lack of time that prevents the adoption and take up of this technology.

In a recent posting on Mr HISTalk Jonathan Bush started a discussion on why getting small groups to use EMR's. The spirited discussion highlights some interestiung points including one of the reasons not to need an electronic medical record - in the words of one physician:
All I have to do is ask and someone will get me the information
It is hard to imagine a more frustrating experience for a patient let alone a doctor being asked the same question over and over again. Not to mention the implication that the physician has the time, full recall and insight into the patient's condition and possible risk factors to ask all the relevant and necessary questions to reach an accurate diagnosis. With the explosion of clinical data this seems an increasingly unlikely proposition. Far better to have the technology help guide that process, capture and store that information so that it can be reviewed quickly prior to and during the patient interaction. I am reasonably confident that I can review a chart (digital or otherwise) and garner more relevant clinical information in a shorter period of time than going through a question and answer session with a patient. I can pretty much guarantee that this is true if the information is presented in a consistent, structured format.

Cost pressures and the cost of implementing tied to the suitability seems more likey to create a barrier to suucessful adotpion. An attitude of:
We’ll take care of the aggravating stuff
Is more likely to engender success. Perhaps not lines down the street but certainly decrease resistance and increase the desire to use technology to help. There's a reason why we have appliances dotted around our house - most are there to make our lives easier. Some are those poor choice impulse buys that remain on the shelf but all the others do make life easier.

There is another big driver looming - the desire of individuals to have access to all their personal health records:

Consumers want access to their info online, hence PHR
There are those who consider this unimportant and even undesirable and there remains resistance to this concept of personalized
healthcare with
concerns ranging from confidentiality of information to patient’s inability to
understand complex medical diseases and the fear that a patient’s record may
become contaminated by inaccurate medical information if we allow patients to
enter and interact with their own medical record.

I fall clearly on the side of patient empowerment and providing more information and like many other areas I believe consumers want more access and more information. As Regina E. Herzlinger, the author of “Who Killed
Healthcare?” stated in a recent presentation that consumer driven healthcare with improved
access to information will follow the same course as we have seen with cars and
personal computer (PC). Consumers don’t need or even want to know all the
workings of a car or PC but ready access to performance, quality comparisons
and details on cars and PC's allows for intelligent choices and overall improvement of quality
and decrease in price by market pressures brought to bear by the informed
consumer. Healthcare needs to follow the same course and it is the consumer
that will be a key driver of this march towards electronic medical records, easier access and sharing of information and the resulting higher quality care

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