So, 2011 is the year the checks for EHR get issued. The IT industry seems to me to be adopting a bit of a wait-and-see attitude about the Federal push to implement and integrate EHR, possibly because the standards for “meaningful use” are only now being rolled out. This is such heavily bureaucratized terrain; not every vendor wants to mess with it. A certain Zen-like patience is required for this market, what with business rules, such as they are, based on the sometimes inscrutable calculations of public-sector analysts and specialists who issue Federal guidelines. I used to work as an analyst for a Health IT company, tracking state compliance to the Federal Medicare data transaction standards, and every time a bureaucrat put me on hold, one more little part of my youth expired, joylessly.
But after all the regulations and rules have been parsed, the rubber must hit the road. Whether doctors and nurses and admins can use the EHR systems being implemented remains the $100 Billion question, no?
From the January 18 PC World:
Dr. Tom Handler, a radiologist and analyst for the research firm Gartner, said one of the main barriers to adoption, “valid or not,” are concerns about the productivity and usability of EHR systems. Many physicians also believe that the data collected by the government through EHR reporting criteria will be used to decrease Medicare and Medicaid reimbursements, Handler said.
“Ultimately, what I hear doctors saying is, ‘Let me get this straight. You want me to spend money to put in a system that will be harder to use and slow me down, so I will earn less money, and that the end result is that someone else makes more money,” Handler said. “If you phrase it that way, it’s not illogical to see why they don’t want to do it.”
E-prescribing is another example. “Docs say, ‘I didn’t go to medical school to become a data entry clerk so Walgreens could hire one less pharmacy tech to enter the system.’”
Handler said current meaningful use criteria also doesn’t take aim with incentives that address what physicians consider some of the most critical reforms needed in healthcare today.
For example, Handler said, a computer-based patient record system can catch duplicate patient test orders, but the current meaningful use incentives don’t penalize physicians for ordering duplicate tests.
Ultimately, it’s the patient — the insurance company and then society — that pays for the duplicate test, and yet, its the physician who’ll have to foot the cost for the system that can prevent the duplicate tests, he said.
Dr. Harry Greenspun, chief medical information officer for Dell and a member of the Healthcare Information and Management Systems Society (HIMMSS), said resistance to EHR adoption can be as simple as a physician not wanting to add steps to a process that has worked for decades.
“It’s really easy to write a prescription; you just jot it down on note paper. On a computer screen it can take a lot longer,” he said. “If you go have to through a check list or a menu-driven program, it can be clunky, and a barrier to adoption.”
“On the other hand,” he continued, “If I can share [radiological] images, pull data from other systems, write a prescription all from one screen … and get valid prescription alerts and find out about public health threats, then the value is obvious.”
Everyone wants doctors and other medical professionals to interact with systems that are as intuitive as possible. The Feds know that usability is make-or-break, and they are developing appropriate usability and quality assurance standards…one hopes. But this is a non-trivial business folks, and there are issues lurking under the surface that give me pause. For instance, there is the crucial distinction between usability and learnability that Andrew Dillon highlights (scroll down to comments):
Distinguish between usability and learnability. Most usability tests are short run tests of people’s initial reactions to a technology. This privileges the earliest phases of human reactions, the making sense of something new. This is important but it is not the full story. I have shown repeatedly in my own work that people’s later reactions take time to emerge and often run counter to their initial ones.
Are your eyes glazing over with this inside-baseball arcana yet? Are you thinking, we pay good money so those nerds with advanced degrees in cognitive psychology or human factors have to worry about this kind of hair-splitting, not us. THAT’S THE WRONG ATTITUDE. Too-big-to-fail projects can fail, and with as much money is at stake with EHR, failure can mean the entire universe is sucked into a fiscal black hole.
Oh, and people can die if we don’t get it right.