I have been going to my family practitioner for years. During these visits I have been able to witness the devolution of the EMR. One thing I really enjoyed about him when we first met was how excited he was about his home grown EMR. He navigated quickly through it and dictated his notes. Then a few years later his affiliated hospital decided to standardize on an EMR. He had to give up his system and adopt to a new one. It was not ideal, and he would tell me all about his challenges, but he was able to use dictation and he completed his notes efficiently. Over time I noticed that his office fell into a nice routine and he could retrieve all the information he needed and dictate notes and orders quickly.
It had been a year since I had seen him and I called for an appointment. I had to provide all my information and none of my insurance information was in the system. You guessed it, they updated their practice management system and EMR. My patient experience went downhill from there. My previous clinical history was archived and not incorporated into the new EMR. So no trending, no real history. Years of electronic, discrete data now converted to a static view only. It is like having your EMR converted to paper, then scanned.
My provider was frazzled, I could tell the way he focused on my encounter and then had to “hunt and pick” his way around the new EMR. No microphone, no dictation, and no customized templates. He confided to me how the hospital system decided to migrate all their physicians to this new ASP platform and they all had to use the same templates. There was no dictation and even if he could, his old profiles were gone, meaning that he would have to retrain the system to recognize special words and speech patterns. Something that he had spent years investing in. Here he was working for a large healthcare organization and they would not use time proven physician adoption strategies. Instead they adopted physicians into whatever their leadership felt was needed.
My scenario is being played out through many healthcare organizations. EMR’s are being replaced because of vendor problems, healthcare acquisitions or just because they have outgrown the capabilities of the existing systems. So why are CIO’s allowing their organizations to use a “slash and burn” technique for system replacement? An even more alarming question is; why are CMIO’s not making a stand against it?
During the sales process EHR vendors focus on their ability to quickly install and train employees on the new system. Organizational leadership views this as an opportunity to get this “information technology” project out of the way so they can move on to the next thing. They might even have this labeled as a Strategic Initiative, tied to bonuses for on time completion.
The thought of having to deal with all the physician requirements and pay for the process of converting all the old data into the new system, is too daunting. Especially when you have software vendors telling them how difficult and costly it will be. Keep in mind that they have a vested interest in getting the system installed as quickly as possible.
I am certainly not going to talk about physician adoption. This has been the topic of just about every HIMSS conference. It also has been at the core of every EMR adoption strategy. So why are we having to visit this again? Because:
- Organizations are focused on project life cycles and fail to factor impact to productivity.
- Hospital leaders often do not understand ambulatory practice operations.
- Leadership incentives are designed to accomplish quick wins.
- CEO’s still do not understand the value of discrete data.
As my family physician entered information into my problem list, medication history (which I had to bring with me from Walgreens for my visit) and reviewed my labs (toggling back and forth trying to find scanned images of my previous lab values) I started to get annoyed. Not at him, but at the hospital leadership that placed more importance on their performance appraisals and ignored the impact they would have on thousands of patients. My data which my healthcare provider and I built for years was now relegated to view only files which could now be printed like a pdf. I am sure on a macro level they could trend on the population as a whole, but I have to rebuild my record, history and trends all over again.
Hospitals focus on episodes of care. Billing is all about the bed stay and the admission timeframe. For ambulatory care it is a longitudinal record. It is all about establishing that long term relationship with the patient. Providers can go months or years without seeing a patient, but are expected to jump into the exam room with a smile, a look of recognition, and an understanding of the patient’s history without having to ask all the same questions all over again.
As an industry we need to do a better job at safeguarding our patient’s records in a way that will allow them to have seamless transitions from one system to the next. Converting data to static views is not only counterproductive, but borderline irresponsible. My personal physician was an EMR champion that loved the technology because of what he could do for his patients. At the end of the day, that’s how it should be for all of us.
