2. Create EMR systems that are so complicated that it takes years to achieve full integration into the practice

I spoke of regulation and certifications in previous posts. Again, I will say I am a proponent of the concepts. I am worried currently about the execution. Actually, one of the primary reasons why Providers currently purchase EMR’s isn’t because of benefits they perceive in the delivery of better patient care, it is the worry they have about meeting documentation and government and payer requirements. They are afraid that they can’t survive the increasing requirements for documentation in a paper world. That is very good news for EMR vendors, but it certainly isn’t why I got into this business. I saw that the only way to improve the quality of care while at the same time meeting requirements was to digitize information and make it available to multiple parties. When we first started building the product it was all about the provider and the practice. How can we improve workflow, increase efficiency, and improve patient care. We did a great deal of work with physicians and administrative staff. However, in the past 24 months all of our developmental work has been in response to Government and Certification Regulations and Mandates. E prescribing, CCHIT Certification, PQRI changes, “Red Flag” requirements, and in our case and additional American College of Cardiology IC3 quality initiatives have driven our product development. Instead of asking the question how can we improve quality of care and drive decision support tools, we are asking the question how can we support the “Red Flag” regulations with the least amount of additional effort on the part of the practice. I guess that is a form of improving efficiency, but it is kind of like I am going to give you a 2% incentive for e prescribing but I am cutting your diagnostic image fees by 22%.

My dad once said to me (I learned to drive a car when we still had manual steering), “It is easier to turn the car when you are driving than when you are standing still.” I think increasing regulations and tightening things down over time instead of during the adoption phase would be more conducive to enhancing adoption. However, everyone seems to think that the consequences of not having all these regulations in place are so severe that it is not worth having a digital system. That logic is preventing the adoption of EHR’s.

The other issue I raised in an earlier post was that of the generic nature of Health Care Information Systems. Clinical medicine is a vast enterprise; it incorporates an incredible amount of information. If you break it into functional areas, you would have to indicate that patient population (i.e., adult vs. child, men vs. women, etc.) is a vital area that needs to be considered. For example there are special needs for children that are different from adults and special needs for women versus men. Likewise, treatment location is also an area that has different requirements. Inpatient settings are different than ambulatory settings which are different than in-home treatment settings and require different tools to function effectively. Health care providers such as physicians, nurses, medical assistants, and physician extenders all have different capabilities and perform unique functions in the health care community. Then take one of those elements like Physicians and break that apart into specialties (cardiology, ophthalmology, pulmonologist, pediatric, etc.). These specialists use different diagnostic procedures, different treatments, different syntax to describe patient medical etiology and treatment. Anyone in this business who is honest with you will tell you that there is no one EHR system that can handle these issues. If you try to create one, the scope of the application and the functionality of it would be so complex that even if it could be built you would have to have a four year university degree to be trained in it. Even CCHIT decided to break certification into areas like general ambulatory, Cardiology, Children’s health, inpatient services, etc.

The general trend in the trade journals and the routine advice given by consultants in the area is to band together and use the community model and receive lower prices by getting everyone to purchase the same system and everything will connect. The long and short of it is that everything does not connect, that implementation takes years, and no one gets what they want or need because the scope is too big for one program to handle effectively. The internet didn’t get to be the incredible platform for everyone to use by waiting for someone to build the giant data warehouse that everyone could use. No, just the opposite; it became what it is because nodes of smaller computers systems all linked together to become the large platform that everyone could use. It still works that why. The problem with it is regulations are difficult because no one “owns” it and too many individuals contribute to it. “It is like herding cats.” There is a down side to that and that is for others to discuss; however, we are pretty familiar with the upside and most if not all would agree we are much better off with the internet than when we didn’t have it.
So, be careful of the all knowing all seeing all wondrous EHR that does everything for