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Time Capsule: Want Doctors to Use EMRs? Find a More Effective Strategy than Shame

March 1, 2013 Time Capsule 2 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 June 2008.

Want Doctors to Use EMRs? Find a More Effective Strategy than Shame
By Mr. HIStalk

Doctors are generally pretty smart. We agree on that, right? So why does the healthcare IT industry keep treating them like idiots?

A new, ultra-expensive study found that doctors aren’t exactly flocking to EMRs (it took an expensive study to determine that?) The hidden message: somebody has to do something to get those dummies to buy EMRs.

EMRs are, in other words, so darned compelling that prospects should be shamed or maybe even forced into buying them for the public good, kind of like seat belts (imagine some models of seat belts that cost $50,000 and require 30 minutes extra every time you start your car.)

In America, doctors are business owners, even though some people think that’s a distasteful concept. They have customers, employees, overhead, and equipment. They make good business decisions or they go broke. You can’t help patients if your practice tanks.

Many of those smart business owners don’t see the value of EMRs. They understand that EMRs might improve patient care in some cases, but the practical and immediate considerations of their cost, support, and time requirements win every time.

Doctors won’t use EMRs just because non-doctors preach at them. They will not be shamed for sticking with paper when it makes personal economic sense. Societal benefit aside, they have to protect their income and their time (which are synonymous).

EMRs, in other words, are no different than any other piece of medical equipment that the doc/business owner might buy. It’s a logical decision made by a smart person. If I’m a doctor, my decision tree might look like this.

First, can it make me money? Doctors buy fancy imaging equipment because they can bill the heck out of it under current reimbursement rules. EMR assembly lines would have to run night shifts to crank enough of them if docs could bill for their use. They can’t, which means payors (including patients) aren’t convinced about EMR benefits, either.

Second, would having an EMR give me competitive advantage? Here’s a question that gives you the answer: would you go find a new doctor just because your old one, who just happens to be the greatest doctor you’ve ever known, doesn’t use an EMR? Neither would all those Joe Sixpacks who are prodded by industry polls into saying that EMRs are essential, but who in reality don’t care whether their own doctor uses one or not.

Third, will using an EMR get me sued less? You’ll know that’s true when medical malpractice insurers give significant discounts to EMR-using doctors.

Fourth, when it breaks, who do I call? Doctors are not hospitals, with their separate department of nerds anxious to tackle the latest problem due to operating system quirks, software upgrades, driver incompatibility, and user errors. The Geek Squad guy is not only expensive and not found in most American towns, he also doesn’t know much about EMRs.

Sticking with the “how we do things here in America” theme, here’s how you get doctors to use EMRs. Make them faster, easier to use, and better supported to the point they provide inarguable business and clinical value, no different than a fax machine or an office PC. In other words, don’t just complain about paper — beat it in a fair fight.

And once you figure out how valuable EMRs are, make the person who gets that value pay for them.

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Currently there are "2 comments" on this Article:

  1. Your most brilliant statement ever:

    “Make them faster, easier to use, and better supported to the point they provide inarguable business and clinical value, no different than a fax machine or an office PC. In other words, don’t just complain about paper — beat it in a fair fight.”

    Complaints about paper continue as witnessed in the Wachter tirade and others about the NY Times front page update on the business of HIT vendors.

    An organized paper chart with hand written orders with computer digital imaging and lab results availability can not be beat for efficiency, outcomes, costs, and attentiveness to the patient.

    Is there a body of literature that states that EMR and CPOE with CDS produces fewer errors, better outcomes, and/or lower costs than paper records?

    What are the aggregate costs of this rush to computerize? More nurses and ancillary support could be purchased with those funds and will likely produce fewer error, better outcomes, and lower costs.

    Please continue to be objective and thoughtful.

  2. “most brilliant statement ever”

    Wow you’re an easy audience.

    If I tell knock-knock jokes I bet I have you rolling on the floor.

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