On December 22, 2014, I posted the first of what will be a series of notes discussing the ineffectiveness of EHRs (see: What's Really Wrong with EHRs: Beginning a Deep Dive). They will make reference to an article addressing the "strategic challenge" of EhRs that I considered very well written (see: The Strategic Challenge Of Electronic Health Records). Because this article was very long and complex, in the first note I only quoted the first paragraph. Below is a second excerpt, digging deeper into the article:
In the era of paper records, hospitals struggled to collect information from across their business units. Nurses attached charge stickers on their sleeves and those stickers got lost on the way to the nursing station. Billing required staffs of experts toiling in dungeon-like record rooms, pulling sheets of paper from files, and manually compiling statements....EHRs were proclaimed the solution to these and other challenges....Electronic orders could improve charge capture and automate billing. EHRs’ potential seemed boundless. But the EHR push lost sight of something critical: Businesses exist to meet the needs of their customers. That is how businesses create value.
As every clinician knows, hospitals don’t meet patients’ needs; clinicians do. Caregivers execute business unit strategy and create value when they interact with a patient and the patient’s health improves. Shared activities can help the service lines of a combined business create more value. Combining human resources, facilities management, and similar services should improve results and lower costs. EHRs are a form of shared service and therefore should support the interactions of caregivers and patients to improve patients’ health. But most EHRs were designed around corporate priorities—billing and high-level record keeping—and their support of the corporate strategy comes at the expense of the service lines. These EHRs treat care as a commodity and raise costs by shifting the burdens of data input onto clinicians. As a result, these EHRs don’t add enough value to care delivery, even though care delivery is why hospitals exist. In fact, care is not a standardized commodity.
For me, the most important sentence above is the following: ...[M]ost EHRs were designed around corporate priorities—billing and high-level record keeping—and their support of the corporate strategy comes at the expense of the service lines. In summary, most EHRs are too complex and are designed to perform too many tasks. It's impossible to optimize both patient billing and patient care simultaneously. The solution to this challenge is to return to separate systems, each developed to support individual "service lines." Pathology and radiology have adhered to this principle since the beginning of hospital computerization with their LISs, RISs, and PACSs.
To further this discussion, I quote from John Moore who blogs over at Chillmark in his year-end predictions (see: Looking into Our Crystal Ball for 2015):
Rapid Market Changes Force Out 50% of Healthcare CIOs: Half of today’s healthcare CIOs will move on in next 5 years as their role radically changes from being one focused on supporting large, relatively static systems to the need to orchestrate highly dynamic systems. We see no end in sight to the proliferation of user selected best-of-breed apps to get the job done – orchestration and governance will be key, project management not.
I frankly don't believe that many hospital CIO are losing their jobs. I am not aware that many CEOs are unhappy with their performance -- yet. In fact, most hospital CEOs would be incredulous at the suggestion that their EHRs, often costing hundreds of millions of dollars, could cause a reduction of their physician and nurse productivity by 10-20%. They believe that the cause of such declines is EHR start-up jitters rather than inefficient and ineffective EHR design. The solution to this problem, in my opinion, is not merely the deployment of specialized, "service line" information systems tuned to the daily tasks of nurses and physicians. Instead, we also need to seek best-of-breed systems. This means that all such specialized systems that come to market need to compete and be compared against each other. There is insufficient competition in today's EHR offerings.