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Time Capsule: Want Physicians to Use Systems? Standardize Screens Like You Do Back-End Interfaces

January 27, 2012 Time Capsule No Comments

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in January 2007.

Want Physicians to Use Systems? Standardize Screens Like You Do Back-End Interfaces
By Mr. HIStalk


The premise of RHIOs and physician portals is that, given the lack of industry coordination, everybody’s computer system stores data differently. It’s up to you (vendor or provider) to match their standard layout. How hard that is for you to do isn’t their problem. If vendors don’t have uniformity on the front end, at least they will on the back end.

It’s an important concept in standardization. The RHIO makes the rules. That’s a political reality, not a technical one. Not surprisingly, providers and their vendors can standardize when they have to. The problem is lack of incentive.

Not long ago, hospitals and doctors were paranoid about sharing patient information. The vital secrets of John Smith’s CBC result or mole removal notes were far too incendiary to let a competitor sneak a peek. Coldly formal hospitals weren’t about to stoop so low as to let the other guy see their data, even though it might improve care for a given patient.

That seems pretty silly looking back. For nonprofits to be arguing over information that could help patients seems incredibly provincial and self-serving (“We’re not telling you what she’s allergic to because you may steal our market share …”). The patient didn’t get to vote, but luckily, common sense prevailed anyway.

With that battle mostly won, let’s move on to doctors. They see patients in two or more hospitals in the same service area, both of which are determined to push their CPOE agenda forward because they spent a lot of money and effort on implementing that system. Doctor, we’d like to make you a data entry clerk.

Hospitals never seem to get how illogical it is to physicians that every hospital buys a different system, but expects community-based doctors who cruise in for an hour a day to master all of them without burning up more hours of their self-employed day. They seem puzzled when doctors jeer at their zealous requests to bone up on Cerner when he or she is fuming at Eclipsys across town and McKesson at the university hospital. Are those systems really different enough that everybody has to buy a different one?

Given the mediocre at best state of clinical systems and CPOE, mastering even one of them as a community-based doc is a stretch goal. Mastering two or more? It will never happen.

When I drive a car, I expect the instruments to work basically the same. If I pick up a TV remote, I don’t want to attend training or read a poorly developed manual. I don’t care how creative your engineers are, I still want the buttons on a telephone to be arranged the same.

Vendors who don’t want to follow standards won’t get my business. A car rental company that decides to creatively swap the brake and gas pedals would fail quickly. Nobody has to pass a law to prevent that; vendors aren’t that stupid. Standardizing the user interface is a market expander that benefits everyone.

In HIT, vendors claim product superiority, but systems have been commoditized to the point where they accept pretty much the same information. There are only so many ways you can order meds, labs, and rads. Still, each vendor manages to design their physician user interface with enough quirks to ensure distinction from competitor offerings. If you’ve seen one system, you’ve seen one system. There’s no such thing as best practices.

Maybe it’s time to develop the equivalent of a portal or RHIO for physician ordering, decision support, and communication. Standardize the user input just like the RHIO’s accepted data format. Why should every doc have to learn every system?

Vendors would hate that, but they weren’t fans of RHIOs either because the importance of their link in the chain was diminished. Data coming from a Cerner system is no better or worse than that coming from a Meditech or McKesson system, so nobody on the other end cares which one you use.

Knowing the HIT vendors aren’t about to support that level of standardization, perhaps some third-party scraping-and-scripting tool vendor could make Meditech look exactly like Cerner for doctors. Think that wouldn’t sell in towns where both are used by hospitals with medical staff crossover?

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