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.