I recently used Uber for the first time. I realize Uber has been around awhile but I guess I don’t get out much. Or, perhaps, I was reticent to try something new. After all, taxis have always seemed like a pretty convenient way to get a ride to the airport, requiring only a call to Yellow Cab, a few minutes on hold to talk to a dispatcher, and another 15-30 minute wait for a taxi to arrive at my house. However, I finally decided to give Uber a try since I had a coupon for a free ride – and free is always better than shelling out $40.
My assessment: Uber was great! I requested the car using the app on my phone. The car arrived in about five minutes and was clean and reasonably new. I love that I was able to put my credit card information on file so there was no need to waste time paying for the fare and calculating the tip at the end of the trip. The car’s location is displayed in the Uber app and calculates the estimated arrival time. Before my coupon was applied the fare was about $25 – far less than my standard $40 home-to-airport taxi fare.
Taxis – and carriages and rickshaws – have obviously been around forever to satisfy people’s need to get from Point A to Point B without walking, taking public transportation, or a private vehicle. While Uber is definitely great for a ride to the airport, it also addresses other needs, namely a convenient way to request service and an efficient way to pay. Oh, and it is seemingly less expensive, at least for now.
My Uber experience got me thinking about other products and services that on the surface appear to be “me too” offerings, but actually provide a completely new experience. One example is the smart phone, which fundamentally changed our expectations for “phone” functionality.
In the health IT world, many existing technologies could definitely benefit from a completely new experience. The American College of Physicians (ACP) seems to agree, at least in terms of EHRs, and recently published a position paper urging a redesign of EHRs. The organization’s opinion is that EHRs have been designed for defensive medicine and billing purposes, are overloaded with useless information, and lack good structure for narrative documentation.
The ACP believes that EHRs need to be redesigned to better fit physician thought processes and workflows. They’ve also asked CMS to consider revising its E/M coding guidelines, which they claim force doctors to backfill their notes to meet the requirements for specific codes instead of the clinical needs of patients.
The ACP offers several policy recommendations for EHR system redesign, including:
- Optimizing systems to facilitate longitudinal care and care involving teams of clinicians and patients
- Designing clinical documentation to support clinicians’ cognitive processes during the documentation process
- Avoiding wherever possible the requirement for users to check a box that an observation has been made or action taken if the documentation substantiates the action
- Facilitating the integration of patient-generated data.
I agree with the ACP that the redesign of EHRs is long overdue. I suspect there are several EHR solutions currently on the market that do offer a “new experience,” but market forces are preventing their widespread adoption. The EHR market is obviously dominated by a dozen well-established vendors and as the industry continues to consolidate, providers are standardizing on a select few legacy platforms. Risk-adverse providers are more likely to stick with the tried-and-true-though-flawed solutions versus bleeding edge products from less-established vendors. Even the most dissatisfied physicians are reticent to try new EHRs because change is scary and often painful. And on the vendor side, the demands of meeting Meaningful Use have left developers with little time to work on other enhancements.
In other words, as much as I’d love to see the Uberization of EHRs, providers will be slow to embrace such a transformation and vendors will require a few more years to develop that truly new experience. Long live the taxi.
Michelle Ronan Noteboom
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