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EHR – Why less is often more…

Having devoted 10 years of my life to the Electronic Health Record (EHR) space, I have seen many EHR product vendors come full circle backwards.  And in my opinion this is great for Health Information Exchange (HIE), hospitals, provider groups and patients.

Early EHR (EMR, CPR…) development focused on delivery of complex products that were designed to manage every task in a provider setting.  Work flow features were especially complex and have had a lot to do with the large number of early failures in this space.  The design process at that time revolved around a “do everything” philosophy.  Not to say that there weren’t some folks preaching a different religion – but for the most part you saw complex products, requiring heavy duty hardware and large implementation projects.

And before I make my point, let me say that I was one of the people driving those complex products.  In my market at that time, those products were and still are a great fit for medium to larger size provider groups looking for ways to transform their practices.  Implemented correctly, those products provide immense value.  And groups using these systems are certainly a large part of the connectivity plans for HIE’s.

Today however, we are seeing these vendors either acquiring or deconstructing their products to deliver the modules that users desire.  These modules vary among vendors, but you typically see ePrescribing/Formulary, Results/Orders, messaging, patient portals… that are easy to implement, browser based and low cost.  This is what the small provider groups were asking for 10 years ago.  They want technology that allows them to run a better business and to improve care without taking out a second mortgage.  And remember that these small groups make up over 50% of our providers.

I also find it interesting that these types of modular products fit very well into the current HIE development plans.  Rather than select complex products that will limit adoption and prove costly and time consuming to implement – a simple web based product, consisting of modular features can be deployed cost effectively which will allow for higher levels of user adoption, better use of limited financial resources and due to the high levels of user adoption, the quality of care benefits that are driving the HIE funding.

I think it it would also be useful to replace the term “HIE” with “Hospital” or “Health System” as it relates to providing technology to non-owned ambulatory providers.  Rather than try to force feed complex systems onto smaller provider groups, give them what they need to get them connected to your organization.   You’ll save money, the providers will get what they want and patients will benefit.

Of course it is never easy.  You still need to invest in a solid system framework to support scalability, analytics and integration.  And the number of vendors that need to be evaluated can certainly be confusing.   But once you get through the planning, you can expect more success by sometimes going with less.

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4 thoughts on “EHR – Why less is often more…

  1. J. Sand MD

    Nice Piece. Let’s grow past the nerd originated, vendor controlled EHR and actually make one that fits. Our small hospital has wasted millions on complex EHR systems that aren’t interoperable and generate reams of reports that are illegible, due to impertinent negatives and poor formatting. Our systems are too keyboard intensive. A simple
    task like displaying vital signs at the bedside seems to be beyond the system. The admin. does not want to admit the emperor has no clothes – and therefore restore a simple paper vital sign sheet that saves doctors time, and helps nurse track the patient’s condition better. Thankfully most docs offices have not succumbed to the hype, and will be rewarded with cheaper smarter (dictation based)EHR systems. Many offices that bought into to the insanity are now owned by hospitals, or have gone back to paper systems. Let’s build a system for patients, docs and nurses instead of payers, researchers,vendors and nerds.

  2. Marty Frygier Post author

    Feisal,
    I appreciate the comment and you are certainly correct. Thanks to HITECH we are seeing a renewed interest in privacy and security. This is an important subject – expect to see more posts from us soon on this topic.

  3. Feisal Nanji

    Good post Marty… One key area that seems to be overlooked in this rush to EMR is how to keep information secure and private.

    We believe that we face a situation in Electronic Health Records similar to what happened to the fortunes of the nuclear power. The promise of abundant, cheap electricity was all but halted after Three Mile Island. Medical records must be maintained using stringent and appropriate technical controls, policies, and procedures. Instead of radioactive leaks, Health Information technology’s downfall could be the theft or unwitting release of sizable numbers of electronic records.

    In our view EHR vendors may have to re-architect their products to provide for better security. Developing key software such as EHR systems are a life and death issue. For example, testing for security weaknesses should not be an afterthought, but instead be required at every stage of software development. Further, EHR systems must be vetted by security experts steeped in understanding attack patterns and malicious behavior. For buyers of EHR systems, we believe that assurances from vendors alone cannot be taken at face value. They must require adequate proof that the system was designed with security as the priority.

    Consider the case of Microsoft, the world’s leading software company. After multiple attacks in the late 1990s on its flagship Windows operating system, Microsoft made security its top priority. It froze all new operating system releases until every identifiable security hole was fixed and stringent security processes were adopted. Today, Microsoft’s security approaches are second to none. The stringent application of security processes within Microsoft cost it money, but arguably it has saved its business.

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