In my recent look around the EMR twittersphere on EMR & EHR, I briefly commented on the challenges of choosing the wrong EMR and EMR Switching. Dan Haley from athenaHealth asked for some deeper clarification of my comment, “I’d say the biggest driver of EMR switching is thanks to the EHR incentive money and meaningful use.”
Here was my response:
I think there are a whole list of things in the HITECH act which encourage and promote the use of outdated technologies. I’m sure this is something you agree with and know all about as well.
My core argument has been, sure we’re seeing an increase in EHR adoption. However, what if the EHR incentive money is incentivizing doctors to adopt the wrong EHR. By wrong EHR I mean one that they don’t like, that can’t adapt to changing technology, that can’t support the future Smart EMR requirements that are bound to come, that kill a physician’s workflow, that cause a doctor to not want to be a doctor, etc.
I think we may be headed this direction and the number of doctors switching EHR software is a decent example of why this is the case. I’m sure that some would argue that meaningful use is driving people to switch EHR software and that the switch we’re seeing happening is from EHR software that isn’t highly functional to EHR software that is highly functional.
While this argument is true in some cases, there are just as many cases which illustrate that the EHR switching was because their first MU EHR was such a terrible experience that they had to switch EHR. Plus, we’re just at the start of this. Many are painfully grinding through the day to day with an EHR they hate. Wait until that explodes.
Even worse is those clinics that are switching EHR for the sake of EHR incentive money and go from an EHR they enjoy to one they hate. Add in the many doctors who are stuck using an EHR that was selected by some large company who didn’t worry too much about the physician needs and we’re in for a crazy next couple years.
Hopefully this gives you a better idea where my comment was coming from. Needless to say, I’m not sure that HITECH has been a benefit to doctors. The short term numbers might look good, but it might have just created some painful underlying difficulties going forward.
With all of this said, there are some beautiful EHRs out there that make doctors lives better. I’m pro-EHR when it’s done right. I just don’t see meaningful use and EHR incentive promoting the right EHR adoption methods.
This provided some interesting background for a conversation I had recently with a doctor. He told me, “It seems like there are a number of false economies driving EMR adoption.”
I think meaningful use and EHR incentive money driving EHR adoption is a false economy. This doctor described to me how many of his colleagues weren’t using the EHR that they wanted, but instead were using an EHR that they “had” to use. What are some of the forced requirements for EHR that create these false economies besides meaningful use and EHR incentive money?
Another False EMR economy is around HIE connections. Many doctors can’t select the EHR they want to use and fits their workflows best because their local HIE may or may not choose to support a connection with that EHR. So, the doctor opts for an EHR that does connect with the local HIE even though it wasn’t their EHR choice.
Hospital Connections is another false economy. Similar to an HIE, many doctors will opt for what they consider to be a less than desirable EHR because it’s the one that works with their local hospitals.
I’m not trying to pretend that doctors should be the end all be all in EHR selection. A physician can think one EHR is the best and not realize until after using it that another EHR would have been better. Sometimes you think you have a great EHR until you actually use another one and realize what you’re missing. However, the easiest recipe for disaster with EHR is for a doctor to hate using an EHR. As I mention above, it will not end well and will drive the future EMR switching that I’ve predicted.
First Posted at EMR & HIPAA on 01/02/2013