Recently I spent a long weekend on an annual girls’ beach trip. The five of us are former co-workers and have known one another for more than 20 years. All of us sold EMR software at some point in our careers, though only one friend is still in that role. Another lucky one is retired; a couple sell non-EMR health IT solutions, and I mostly sit at my keyboard and ponder the world of HIT.
One evening over cocktails we reminisced about the good old days, before the Internet and online demos. Twenty years ago we demoed software on full-size PCs or small mainframe servers. We’d haul boxes of computer equipment in the back of our cars as we traveled from practice to practice. Sometimes we’d lug our equipment to the airport and check the computers and monitors as baggage. There was no such thing as “business casual” and our typical work attire included a skirt, jacket, high heels, and panty hose. There were many long, physically tiring days.
Actually, selling EMR 20 years ago was pretty fun. Doctors and administrators were enthusiastic about the potential of getting rid of paper charts and massive chart rooms and putting their records online. Physicians loved the idea of not having to carry paper charts from office to office or office to home. Administrators were thrilled that chart notes would be more legible and support higher level coding. Staff was giddy that notes could be faxed to specialists or insurance companies without ever having to print a single piece of paper. Oh, the efficiencies EMR would bring! The doctors would go home earlier and the ROI would be incredible!
At the time our product was cutting-edge, which further enhanced the experience. When my little pack of recovering EMR sales reps and I looked back, however, we wondered if those first-generation EMRs ever lived up to their promise. Heck, even as EMRs have evolved, have any of these products made doctors more efficient? Improved care? Created cost savings?
The reality is that despite the enthusiasm of those early adopters and their sales reps, most of those first EMRs were hard to implement and expensive to buy and maintain. Technology has improved but we still have a ways to go. The computer still gets in the way of the physician-patient relationship. Interoperability with other systems remains a financial and technological challenge for many practices. Physicians might be going home earlier but only because they could access charts from home to complete their documentation.
Our EMR discussion left me a little depressed. Had we really invested all those years selling products that failed to make the world a better place?
The next day – before cocktails – we begin round two of our EMR discussion, which focused on the ways EMRs have improved healthcare. We agreed that e-prescribing, lab ordering, and results reporting were among the biggest overall wins because the new processes were faster and more efficient than the old paper methods.
We came up with several more solid benefits but in the end we pondered why EMRs have failed to achieve the overwhelming success we had anticipated.
I believe it comes down to three things: usability, workflow, and money. Doctors have not fully embraced EMRs because we haven’t found a way to deliver a product that doesn’t slow them down, particularly during the patient exam. When the documentation process is not intuitive, doctors end up concentrating more on their computer screens than their patients. We still must tweak the design and implementation of EMRs so they don’t interfere with the patient care process.
EMR vendors have dedicated years developing solutions that mimic pre-EMR workflows and not disrupt doctors’ established routines. Despite many good niche products, nothing has universally “stuck.” Should developers keep trying or should doctors just be more accepting?
As for the money: EMRs are expensive to buy and maintain. Regardless of incentives, providers end up paying for the bulk of the costs. For a large health system, the benefits of shared records may easily justify the expense. However, independent physicians shoulder a high cost per doctor yet arguably benefit less than other stakeholders. Is that fair?
As a recovering EMR rep, it’s hard not to be disappointed that the solutions I sold fell short of the promise. Then again, we continue to make headway so I remain optimistic.
Maybe one day the girls and I will celebrate the wonders of EMRs over cocktails.
Michelle Ronan Noteboom
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