5 points of view from an EHR end user

By Michelle McNickle
11:51 AM

Discussions surrounding EHRs and their adoption (or lack thereof) have grown into heated debates concerning their usability and effectiveness. And the most vocal folks, whose opinions could very well change the way EMRs work, are none other than the end users themselves: the clinicians.

That’s why we looked to David Hager, MD, to debunk some of the myths and explain some of the gripes he and his colleagues have with EHR systems. 

“I’m a life-time geek who played Star Trek on a teletype machine and learned to code in C from Kernighan and Ritchie’s first edition book,” Hager said. “I’ve built multiple websites from the ground up, handcoding much of the javascript or PHP content. I’m identified among my peers as the computer guy who carries the flag of discontent with awkwardly cobbled products over which we had no choice, and which slows us down by virtue of poor designs, and poor network infrastructure planning centrally.”

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With that said, Hager gives us five points of view from an EHR end user: 

1. Just how bad is it? “The nature of our problems propelled a line of thinking that I hope might be useful outside of our own paralyzed system,” said Hager. To him, daily experiences with “clunky interfaces, awkward data entry, mind numbing popups, excessive mouse clicks, nonsensical forced choice radio buttons, slow response times, loculation of information, lack of integration or analysis, and identical looking notes,” is unbearable. “None of this would have inspired me to buy an EHR with my own money,” Hager added. So instead, he developed workarounds with word processor macros, spreadsheets, and .PDF software to do what the EHR can’t and won’t. 

[See also: EHR adoption still a top concern for physician practices.]

2. Alternative systems are hard to implement. Hager said his colleagues harbor the same feelings of discontent toward the EHR they’re using. So naturally, Hager began to wonder: Why can’t they find a new EHR? “Cost,” he said. “Yes, there’s the prodigious cost of a new product, but then there’s the problem of migrating existing patient data to the new product. Vendor lock.” If a practice makes a significant capital investment on a go-forward basis in an EHR system, said Hager, but it realizes the decision was a mistake, there’s little they can do about it. “Now their patient records are locked in a bad product, unless the practice is in the enviable financial position of being able to change products,” he said. “It will either muddle unhappily along with the bad product, or dump the records back to paper. The cost of a new EHR plus the cost of data migration equals prohibitive cost.”

3. Physicians are open to new technologies. Believe it or not, Hager said physicians are indeed eager adopters of technology that helps them work faster, more effectively, or more profitably.  “Since EHRs weren't meeting those standards, and we weren't buying them, especially at the going total cost of ownership, the government decided the problem was not with the EHR products, but with the doctors,” he said. “And so, [it] enacted a program to carrot/stick us into using them.” Hager pointed out similar programs weren’t necessary for the adoption of CT scanners, PET scans, robotic surgery devices, ambulatory EEGs, gene sequencing, and even smartphones. “So why create a program to force adoption of EHRs?” he questioned. “Because we didn’t like them. They weren’t market ready.” 

[See also: EHR alliance to help physicians adopt IT.]

4. Try giving physicians what they actually want. In reality, said Hager, if EHRs offered clinicians what they wanted and needed, they’d be flying off the shelves. “Steve Jobs understood that,” he said. “Provide a product that inspires and moves a customer beyond the mechanics of software and hardware.” Hager looked to a colleague to describe the EHR they’re using. “Our EHR, ‘lacks the level of sophistication and integration necessary to capture my imagination and fuel a desire in my mind to think of ways I can use it to help make my job easier and enrich the lives of my patients.’” In his own experience, Hager added his EHR has failed to work for him. “I work for it,” he said. “I’m a data entry tool that serves the product. It does little for me in return that a paper record can do better and more reliably. It’s recognized within our medical staff that our EHR is not a tool for clinicians – it’s a tool for administrators."

5. Flexibility is key. Despite his gripes concerning EHRs, Hager believes there is a solution that could work and even make EHRs something physicians “actually crave.” “If clinicians can change EHR products at will, with little or no data migration cost, they are likely to try multiple products until they find what they like,” he said. In a scenario such as this, he said, market competition would be fueled by freedom of customer choice, driving vendors to produce what clinicians want at more competitive prices. “How to get there?” Hager asked. “Standardize data constructs. HIE developers want that so HIE will work. Apply the same concept to the main body of patient data, and not only will HIE be seamless, but EHR products can become interchangeable.” Structure the data first, Hager added, and design the products second. “That progression helped to fuel the wild explosion we call the World Wide Web.”

Follow Michelle McNickle on Twitter, @Michelle_writes

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