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Being John Glaser 3/16/09

March 16, 2009 News 6 Comments

Virtually all major technology innovations result in good changes in society and introduce new problems.

The automobile opened up the country and accelerated commerce. It also spurred global warming and people died on the highways.

The Internet enabled new ways to find information and forge communities. It also supported new forms of identity theft and eased access to unsavory material by children.

The television brought diverse entertainment and education into the living room and enabled the real-time participation in world events. It also contributed to sedentary lifestyles and the homogenization of culture.

Widely deployed interoperable electronic health records will bring good changes and introduce new problems. While the net impact of EHRs will be positive, we should acknowledge that their use also brings a downside. EHRs are no different in that regard than any other major technology innovation.

Individuals and organizations that point out these problems should not be discounted as Luddites, narrow thinkers, or resistant to change. While some of the con-EHR commentary can be discounted, we need to listen to it.

The point is not to pooh-pooh those that point out problems. The point is to understand the new problems and devise ways to mitigate or remove their impact. Seat belts and emission controls were steps taken to reduce the problems created by automobiles. Various applications have been developed to reduce Internet-based identity theft. The explosion of TV channels enables a wide range of cultures to express their voice.

Those who note that EHRs can hinder the connection between a provider and a patient, add too much time to simple tasks, and result in problematic privacy intrusions are right. EHRs will do these things.

We have to find better ways to make these problems less of a problem.

John Glaser is vice president and CIO at Partners HealthCare System. He describes himself as an "irregular regular contributor" to HIStalk.

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Currently there are "6 comments" on this Article:

  1. John Glaser. I appreciate your honesty and humility. You are one of the few HIT leaders willing to admit that we have an obligation to examine what researchers (as compared to vendors) find about our products.

    We spent so much energy attacking researchers like Drs Jon Nebeker, Ross Koppel, Yong Han, B-T Karsh, the GAO, etc. I think it was Koppel who suggested it would be more productive to focus our efforts at making better products than at raging against objectively studying HIT.

    Thank you.

    Chuck B.

  2. John, you deliver a simple and honest message/reminder, thank you.

    The EMR is a tool, not the Holy Grail that will instantly provide a better health care system.

  3. John,

    Brilliant posting with a simple argument and presentation. It is so rare to see such clarity and conciseness in these discourses. Well done!

    I too believe in the absolute importance of trying to minimize or mitigate less desirable consequences from highly desirable advances.

    Where would you suggest independent EHR/EMR implementation consultants focus their efforts to spread the word about these considerations and to help their individual clients navigate them to establish a list of priorities. In other words, what can we do to help establish a clear roadmap and best practices for these implementations since one can not “Google” and find one out there?

    Thank you again.

  4. John Glazer has hit the nail on the head regarding the mixed bag of results that technology brings. The technological innovations he cites are perfect models for the introduction of EMRs to physicians’ offices. The way to “make problems less of a problem” is to start simple.

    Take the television set, for example. The first TV was a box with an on/off button and featured a few channels. People found it easy to use and an entertaining addition to their lives. Imagine how perplexed they would have been had their first television been a media center, replete with a cable box, a DVR, DVD, surround sound and multiple remote controls with scores of buttons and thousands of stations from which to choose.

    Automobiles, although sophisticated for their time, were similarly basic in design. They made transportation much more efficient, and were not too difficult to drive. They weren’t complicated by electronics and features—radios, GPS systems and dashboards full of buttons, symbols, lights and gauges—and, therefore, people were excited about the prospect of owning one and could operate them successfully.

    We are trying to add too much complexity to EHRs too quickly by weighing them down with features that are intimidating and not necessary at the outset. As with all technology, successful EHR adoption will come if we start simple. Encourage physicians to implement easy-to-use systems that yield them important benefits, and let the technology evolve over time.

  5. One way to find ways to make these problems less of a problem is to include user interface designers in the process of making and improving EHRs. These professionals are trained to observe people in the context of their work, collect information, and design software interfaces that people can use (and might actually enjoy using).

    Can you tell what I do for a living 😉

  6. Remember the early Honda Civic, basically a box on wheels? It grew into a pretty nice little, very popular sedan. Now, it’s even a leading edge hybrid, but it started simple with “true function” prioritized, tweaking as it grew. Seems a great lesson for how to entice non-geeks docs (most) to take an EHR drive.

    Professional designers for user interfaces? A must, I would think. (Most EHR UIs are abysmal.) But think we need to ask the non-geek, yet-to-be-end-users for their impressions. They are who we need to understand and engage.

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