FierceHealthcareFierceHealthITFierceHealthFinanceFierceEMRHospital ImpactFierceMobileHealthcare   FierceCIO

The hidden side of EMR adoption

October 15, 2007 — 6:59am ET
Tools
Tags
Electronic Medical Records (EMRs)
adoption
incentives


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

Click here to get the FierceHealthIT email newsletter for FREE!


Comments (5) | Post a comment

Comments

By Anonymous | Posted 3:54pm | October 22, 2007

I've done some truly extensive research on this issue, and I do have to agree with "Freakonomics" here -- I think that the answers are not where they are expected. I believe that I have put my fingers on some of the issues, at least. Once I went even a little "public" with my thoughts, two things happened: (1) The doctors I was working with loved it. (2) The big moneyed EMR interests made damned sure my little bitty company wasn't going anywhere, anytime.

By Anne Zieger, editor | Posted 8:59am | October 23, 2007

I'm sorry to hear that you feel your comments were squelched when you spoke up regarding EMR adoption issues. I can tell you that I get many comments from readers who are also questioning the established wisdom on this subject, so you're far from alone, at least.

By W. Sivill | Posted 2:29pm | February 4, 2008

I agree that no one understands the true reason why the rate of EMR adoption has been so slow. Certainly the often discussed factors including cost; the lack of IT sophistication in small practices and the reluctance of many physicians, especially the older physicians, account for many but not all of the reasons.

I do believe you hit on one point in your article with "the extent to which a physician's specialty demands flexible data access" being, I believe significant. Clearly, the data intensive specialties such as family practice and internal medicine should have a higher need than less data intensive specialties such as refractive surgery or cardio-thoracic surgery in which the patient is typically seen once before surgery and once maybe twice post operatively.

By Anonymous | Posted 2:05pm | April 21, 2008

I need to roundly agree with the first "anonymous" poster on this issue.

I did a huge amount of research, including working with a large number of physicians, medical insurers, and liability insurers. I felt that I had made a couple of important, well, if not "breakthroughs", at least significant headway in understanding "adoption" issues.

Two things resulted:

(1) The VCs said "we'll listen to you. But, whatever it is you have to say? Doesn't matter -- we're not funding it.

(2) Got killed quickly by the moneyed interests who have gazillions of dollars on "secretarial EMR".

We went belly up pretty quickly. And here it is 2 - 3 years later, and I STILL feel that I was and still am ahead of the curve.

By D Martis | Posted 3:07pm | February 18, 2009

Anne,

I have followed your articles on and off over the last year and have found them to be insightful and 'ahead of the curve'. I agree that EMR cost is not a drawback if presented as a 'value add' proposition to medical providers.

We have designed a comprehensive, authenticated EHR system that you might find interesting and I would love the opportunity to share it with you and solicit your thoughts.

Please e-mail me with your availability.

Post new comment

The content of this field is kept private and will not be shown publicly.

More information about formatting options

To combat spam, please enter the code in the image.