Money is not the problem

I began to understand the EMR adoption problem one day when I needed to make a "to-do" list. In the past, I've made such lists on my PC, creating another e-document along with the dozens that litter its desktop. If I was lucky, I might remember to check it once during the day, but usually, I ended up disorganized and playing things by ear anyway.

On the other hand, when I put the list on paper this week, and could cross items off manually, voilà! Things got done. A paper record, as it turned out, was far easier to scan and edit, and somehow, viscerally satisfying to use. Marking up a document creates a unique visual structure for data, one which is totally intuitive for the user.

This, in short, is why many medical groups aren't ready for EMRs. Don't get me wrong, I'm sure they're taken aback by the $40,000-per-physician cost, and others simply aren't very computer-savvy. But when it comes down to it, they're particularly concerned that EMRs aren't a great substitute for paper, which, in reality, is a quite a powerful tool on its own. Right now, physicians can use paper records to make, in essence, a "mind map" offering at-a-glance insight on their patient. And the bonus is that it never needs server backups and it never crashes.

Meanwhile, even the best-designed EMR has workflow assumptions built into it which might not match the physician's style. At minimum, doctors will need to adapt to a) the user interface, b) the software's business logic--which can dictate the order in which things get done--and c) the medium for accessing the software (laptop? handheld PC? PDA?).

If I were a physician, the idea of making all of these changes would scare the heck out of me. Anything that throws a doctor off of his or her stride can lead to serious problems, ranging from the trivial (patient irritation) to the catastrophic (harmful or fatal mistakes). And even if I was pretty sure that no one would get hurt, having less control would be uncomfortable at best.

Of course, smart physicians are aware that over the long term, a well-designed EMR can save time and money and reduce medical errors, as well as making it much faster and easier to share data with other community caregivers. I have little doubt that in theory, virtually 100 percent of physicians would like to see this happen.

But to get there, doctors are facing far more then a big investment; they're looking at changing patterns which feel right. Getting them to fix something which (from their perspective) ain't broken will be quite a trick. - Anne

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