Docs not tech savvy, or tech not doc savvy?

Written by David Sullo MD., FAAP

I recently wrote a post about why your pediatrician may not be using an electronic record. Uptake has been slow largely because doctors believe their daily work would not be made significantly easier or more effective with the current systems available. Furthermore, if they do invest in one and it is not a good marriage, it is difficult to then switch systems.

The government has taken the top-down approach to this issue, otherwise known as the “let’s throw money at the problem” approach. Physicians that can show what is termed “meaningful use” of an electronic record are eligible for financial reimbursement from the feds. This has led to some unintended consequences. First, physicians are chasing that money by purchasing systems that may not meet their needs, because time is of the essence (the program expires). Second, EMR developers are focusing on the government’s criteria for “meaningful use,” at the expense of other functionality. This will lead to some very bitter doctor’s offices in about 3-5 years, when the money runs out and they don’t like the EMR they chose. However, the government will have very nice graphs about how their program increased EMR use in physician offices.

My belief is that the government should have taken a bottom-up approach to this issue. A standard database for medical information needs to be deployed. Electronic records are basically a large database. However, each company creates this from scratch, and because of this they are all speaking different languages. This makes it difficult to send data from one system to another, and even more difficult to switch systems within a practice if your first one is a lemon. A good analogy is the Internet. Webpages are written in a standard language (HTML). No matter whether you use Internet Explorer, or Firefox, or Chrome, a given webpage looks the same. Now imagine if this were the case in the medical field. If all EMRs had to use a standard database, it would lead to several things:

First, the communication problem between EMRs would be solved, because they would all be “speaking the same language.” No more costly interfaces.

Second, it would make it infinitely easier to switch EMRs. This would remove one of the main barriers to adoption that currently exists. Just as I can easily ditch IE and switch to Firefox and the CNN website still looks the same, I would be able to ditch one EMR for another without losing my patient’s data.

Finally, because of this ease of shifting from EMR to EMR, developers would have to actually compete on function. I think this would be the development that would allow electronic records to finally hit the mainstream. I have often wondered what an EMR designed by Apple would look like. If the government would remove barriers to competition, rather than try to legislate EMR into existence, we might indeed someday have “an app for that.”

Dr. Sullo is a pediatrician at Genesis Pediatrics in Rochester, New York. He admits to having gone to computer camp in 5th grade when everyone else was playing baseball, and is an “Apple Fanboy.” He does his best to offset the geekiness by throwing in some winter backpacking.

3 thoughts on “Docs not tech savvy, or tech not doc savvy?

  1. Great blog! For a solo pediatrician like me who still will have to invest a lot of money to go to an EMR despite the gvt incentives, this is a very scary proposition. I always thought computerized records and office management sounded like a great idea, and about 5 yrs ago I spent time at another doctor’s office watching him use his EMR. Needless to say, I found it cumbersome and just not functional. EMR’s unfortunately have not changed much. Both pediatric hospitals in town are offering to help financially to go electronic, but the systems they offer don’t convince me. This is really tough at a time where my income has been reduced and my overhead keeps growing.

  2. Great Post!

    I have converted to EMR- it definitely slows me down.
    And now with “meaningful use”, my EMR provider is spending all their programming time on meeting those requirements, which do not benefit pediatrics at all. Fixing my growth charts and vaccine reports has moved to the bottom of their “to-do” list.

    The inability for different systems to communicate is ridiculous! I get a patients medical records on a disc from their previous provider’s EMR, I have to print it out and scan it back into my system! What a waste of time and paper!

    Also- many pediatric practices will NOT be eligible for any government money because they need to have set percentage of Medicaid patients.

    So- while I do like my particular EMR, I am not that pleased that I converted……..

  3. Until the folks who write the software actually use their product,’the next best thing sounds like your idea! Incentives from the bottom up.

    If GoogleFlu worked as well as they say…let those guys take a whack at personal health records. Me? I’ve got a patient to see…and a copay to collect, and a claim to file, and a referral to get, and a form to compete …

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