The majority of provider organizations have invested in an electronic health record (EHR). But there appears to be room for improvement. Health care professionals are increasingly voicing frustration with their EHRs. Why? “Poor usability, clunky interfaces, ineffective search and too many clicks,” according to a recent Healthcare IT News article, Doctors Demand Extreme EHR Makeover … Right Now. Other items on the “wish list” include interoperability and the ability to add on new applications, advanced search functionality, easier copy-and-paste functionality, and customizable views.
A Rand survey on the topic, 9 Reasons Physicians Hate EMR – The 2013 RAND Study, reported on the EHR functionality that most clinical professionals would like to change. These include:
- Time-consuming and redundant data entry
- User interfaces do not match clinical workflow
- Intrusion on the face-to-face interview
- Insufficient health information exchange
- Information overload
- Mismatch between meaningful-use criteria and clinical practice
- EHRs threaten organizational finances
- EHRs require physicians to perform lower-skilled work
- Template-based notes degrade the quality of clinical documentation
If the clinical community can be so specific about what doesn’t work well in their EHRs, why haven’t the EHR vendors fixed these problems? To answer that question, it is important to keep in mind the “realities” of the EHR market that cause a disconnect between technology and its users in the consumer, provider organization, and clinical professional communities. I think there are four factors that have a big impact.
A Lack Of Alignment Between Vendors And Their Clients
Provider organizations can get out of sync with their vendors very quickly, and for a lot of reasons. The vendor themselves are often the problem, and have completely different goals than the client. As publicly owned or private equity-backed companies, the demand for quarterly performance, year-over-year growth, and market share is diametrically different from the needs of a non-profit organization seeking to change the lives of the people they serve. And while vendors have great vision for how their solutions fit into the overall health care ecosystem, execution fails to meet the expectations they set. Think meaningful use and how every vendor took advantage of federal rule-making to sell needed add-ons. Then look at how well organizations are actually using their solutions in a meaningful way.
As a result, the needs of the client and the capabilities of the technology often do not (and will not) align. And surprisingly often, the provider organization signs a bad contract (with a vendor who needs to close the business by the end of the fiscal period), which clearly isn’t in their strategic best interest. Your solution: patience and due diligence, again and again (see EHR Implementation Not What You Had Hoped For? Join The Crowd).
Consolidation In The Vendor Community Affecting Client Experience
Once upon a time provider organizations could ask themselves if they wanted a very large general health EHR company, a smaller specialty EHR, or a very small “boutique” EHR (see In EHRs, Does Broader Or Bigger Or Smaller Make A Difference?). But as the EHR market continues its consolidation, those days are numbered, if not already over, resulting in companies offering solutions supported by disparate teams cobbled together over the course of multiple acquisitions. Unfortunately, the customer experience hasn’t improved during those consolidations, leaving many organizations with far less choice than they had just five years ago.
Vendors’ Need To Preserve Legacy Systems
“Legacy” EHRs are everywhere, and many of them are a security or HIPAA crisis waiting to happen. Even systems touted as “new and improved” are often based on technology that was developed almost half a century ago. Unfortunately, vendors can’t simply replace old technology with new, and many organizations can’t simply “turn them off” without significant disruption to their operation. When selecting vendors, finding one that can “preserve the good” while offering state-of-the-art solutions for better data security and modern-era functionality is vital to future success.
A Need For Greater Collaboration And Technology Disruption
If you’ve ever implemented an EHR, you’ve heard the horror stories about one vendor who “took the data hostage” and wouldn’t release it to another vendor (or the provider organization, or the consumer). The reason often cited is a lack of interoperability between systems. Whether that’s true or not, I think this situation definitely highlights a lack of cooperation between vendors, provider organizations, and any other stakeholders involved. When choosing vendors, make an accurate judgement about just how cooperative they will be (see Are EHR Vendors Holding Patient Data Hostage?). More importantly, the industry is set for a technology vendor to disrupt the industry, to “Uberize” needed features, functions, and approaches to how they advance their solutions. New subscription models, on-demand services, self-service analytics, and predictive modeling all have a role to play in the “makeover of EHRs.”
Technology is an important part of strategic success – particularly when value-based reimbursement (see For Many Provider Organizations, The Shift To Managed Long-Term Care Is A Double Whammy) and your health information exchange (see You Have An EHR, But Can You Share Data?) are issues. Understanding the dynamics that shape not only the health and human service system, but also the health care technology ecosystem, is critical. For more on making an information tech choice, join my colleague Joseph Naughton-Travers on November 6 for the session, Do You Have The Right Tech Strategy? An Executive Seminar On Technology Selection & Budgeting, in Philadelphia, Pennsylvania.