Mr. HIStalk offers both an enlightened and eloquent exposition of the consequences of the roll-out of an EMR in a health system. The blog note is organized as what he refers to as ten "universal rules" (see: Mr. HIStalk's universal rules for big EMR rollouts). His piece is in response to the following news that Sutter Health's deployment of the Epic system seems to be out of control in terms of its cost. Recall a number of previous notes about Kaiser's problems with its own Epic system.
Sutter's original estimate to install Epic in six hospitals: $150 million. Current estimate: $500 million and going up. Nearly $100 million for one hospital? Says they learned from Kaiser's mistakes.
You really need to read Mr. HIStalk's whole list because the same mistakes seem to be repeated over and over again as if they are foreordained. The "universal rule" that caught my attention in the list was the following:
Doctors won't use [the new EMR] like you think, if at all, because hospitals are one of few organizations left that doctors can say 'no' to.
Everyone understands that physicians have difficulty saying no to the health insurance companies. They certainly can't say no to most of their patients unless they have gone slightly mad. The can't say no to the federal government which one of the most important payers of healthcare costs. However, let's briefly explore the general proposition that they can and will say no to hospital CEOs regarding the deployment of an EMR.
I think that it's safe to say that it takes more time for a physician to input a drug or lab order into an EMR than write the same order by hand. This is because, in the case of the hand-written physician order, numerous hospital personnel serve the function of translating and communicating it. One of the reasons why e-commerce can be so profitable is that it transfers much of the transactional work to the customer and thus wrings many of the labor costs out of the process.
Physicians tend to be exquisitely sensitive about their professional time management and efficiency. I believe that the majority of physicians endorse the concept of e-health and understand the myriad advantages of electronic health records. What they reject (i.e., what they say "no" to) is the transfer of the work of the EMR-enabled transactions to them. I do not believe that EMRs will become simpler in any way in the future -- in fact, they will only grow more complex (see: Lab Software and the Trend Toward Complexity). Therefore, the best way to obtain greater political support for hospital EMRs in the future is to design these systems such that physician interactions with them, at least vis-a-vis data input, is kept to the bare minimum. Let's bury the term computerized physician order entry (CPOE).
:: Update on 11/19/2007 @ 8:05 a.m.
Mr. HIStalk's Universal Rules get trademarked.
Comments