The hidden side of EMR adoption

In their bestselling book Freakonomics: A Rogue Economist Explores the Hidden Side of Everything, economist Steven D. Levitt and journalist Stephen J. Dubner go to war against relying on conventional wisdom to explain economic decisions. The two authors contend that the key to understanding group behavior is to find the hidden, powerful incentives that motivate such behavior, rather than making broad assumptions about the impact of, say, race, educational or professional status.  

For example, you may be surprised to learn that street-level crack dealers aren't living in luxury, but rather, typically make less than minimum wage and live with their mothers, according to data gathered by the two. Without that data, any solution you propose to cutting the drug supply will probably misfire.

Freakonomics doesn't take on the hidden factors impacting physician EMR adoption, but it seems to me that a similar approach is badly needed here.

From what I've seen, much of the discussion and research on physician EMR adoption starts from the premise that EMR system costs are the key problem holding doctors back. I'm not saying that it's a foolish assumption--but does it really explain their behavior?

As we've noted previously in FierceHealthIT, there's clearly many other factors coming into play, including the extent to which a physician's specialty demands flexible data access. And certainly, some research has taken a more comprehensive approach, looking at the extent to which, say, technical issues or concerns about workflow problems are holding physicians back.

Still, most state governments seem inclined to throw money at the problem -not to mention hospitals, who are frustrated enough to actually give costly EMR systems away. While the jury is still out, I haven't heard of any major success stories arising from these approaches to date.

All told, I'd argue that as hospitals, insurers and the government crank up their campaigns to push EMR adoption, it's well and truly time for them to do a little freakonomic analysis of their own. To my view, it's pretty clear that those who want physicians to buy and/or use EMRs haven't dug in deeply enough to understand what's holding things up. If they do, however, I think they'll like the results. - Anne

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