EMRs are Walk-in Refrigerators

By Mary Baum
10:09 AM

In his most recent article for The New Yorker, Atul Gawande drew some impressive comparisons between the efficiency of the U.S. healthcare system and one of the country’s most successful restaurant chains.  At first I thought it was a bit of a stretch, but as I read about the inner-workings of The Cheesecake Factory and the organization’s method for serving millions of Americans while preserving a consistent standard of quality, the parallels became clear (and I suddenly craved Thai chicken lettuce wraps). But one misconception I wish Dr. Gawande had taken the opportunity to clear up was the prevailing myth that electronic medical records (EMRs) are the solution to healthcare’s problems.
Every day I visit hospitals around the country and examine their workflow – which to me includes people, processes and technology. My goal is to help them get at the heart of inefficiency, reduce clinical errors and patient risk, and ultimately prepare them to handle the eventual shift to a pay for performance model. The most common mistake I see when talking with CIOs, CEOs and clinicians at those health systems is the firm belief that technology – specifically EMRs – is ultimately the most critical vehicle they need to reach their goals.
EMRs alone will never be able to fix bottlenecks, improve workflow or build a better team. They are repositories for information – very critical information at that, yes. Without them, the amazing caregivers of the world and administrators of hospitals could not do their very challenging and admirable jobs. But it’s in the same way that, in Dr. Gawande’s analogy, chefs and line cooks and waitresses wouldn’t be able to deliver meals to millions of tables in America without pulling from walk-in refrigerators and stock shelves. They are just one piece of a very complex puzzle, and the magic and beauty of quality healthcare happens when everything in between is tightly orchestrated and working together.
In and of themselves, EMRs are unable to bring together a team in a way that enables seamless patient transitions, responds to potential patient risks and make sure clinicians know the protocols that are necessary to do their jobs. In The Cheesecake Factory kitchen, what is it that enables the order to be placed, the chef to read the ticket, the steak to go on the grill and the potatoes to be done at just the right time so that the waitress can deliver a perfect meal every time? The platform and process running across all those functions, tools and people are what makes it all work and without them, the middle-aged couple out on date night decide not to leave a tip – or worse yet, get food poisoning.
Don’t get me wrong. I love EMRs. And I love refrigerators – both serve very important purposes. But I want the industry to take a step back and see EMRs for what they really are and start focusing on all the other elements surrounding the EMR. Look there, and we will all take a big collective step closer to understanding how to improve patient care.
Remind me to send Dr. Gawande a piece of cheesecake.


Mary Baum is chief health care officer at Connexall.

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