The Clapper, the hammer and the EHR
Does anyone remember the Clapper? Y'know: "Clap on! (clap, clap) Clap Off! (clap, clap)." With the sound-activated Clapper, you simply needed to clap your hands to turn on and off a light – thus eliminating the exhausting task of getting up from the couch and walking across the room to flip the light switch.
Imagine the efficiency of such a tool and how beneficial for couch potatoes (and the handicapped). Unfortunately other noises, such as a dog barking or a door slamming, could also trigger the Clapper. I know I'd be quickly annoyed if my lights turned off and on every time one of my dogs noticed a squirrel out the window. Clappers worked well for some people, but the technology was clearly flawed.
In contrast, compare the problematic Clapper to the effective and efficient hammer.
For time immemorial, the hammer has been the go-to tool to facilitate the insertion of a nail into a piece of wood. (You might be able to accomplish the same thing with your bare hand, but it would likely take longer and be a bit painful.) The tool has wide appeal because it functions well, is intuitive to use and can be mastered with minimal training.
So what do Clappers and hammers have to do with health IT? Like Clappers and hammers, technologies such as EHRs are simply tools. In the case of EHRs, the tool should ideally enhance the health of patients; they should be intuitive and easily mastered. They should be well-tested to minimize the chance of arbitrary errors that threaten patient safety.
I recently questioned whether it really mattered if physicians actually liked their EHRs – as in, should we focus our efforts on improving the usability of EHRs, or, should we prioritize technology enhancements and policy discussions to advance the creation of a "single, interoperable patient record that enhances the quality of care?"
Not surprisingly, a number of physicians reached out to let me know that their opinions about EHRs absolutely did matter! And I agree. However, let's not lose sight of the ultimate goal, which should be providing clinicians with easy access to critical patient information at the right time and in a format that is usable and friendly.
EHRs are just tools to create the building blocks for the ideal interoperable record. Clearly physicians need EHRs that are more akin to "hammers" than "Clappers." Because if EHRs don't enhance workflow, physician adoption will suffer and the blocks will take longer to build.
At the end of the day, everyone hopes that EHRs will improve healthcare to the same extent that computers revolutionized banking. We are not there yet, but EHRs are still relatively young and evolving.
If you ever saw the 1987 movie Wall Street, you'll recall Gordon Gekko and his brick of a cell phone – which happened to be bleeding edge technology in its day. It took almost 30 years for cell phones to advance to today's smartphone technology that can be used for phone calls, texting, video calls, email, accessing medical records and more.
The perfect EHR – assuming there is such a thing – won't happen overnight. Physicians will still need to suffer through a few Clappers until EHRs achieve hammer perfection.