The EMR rollout dilemma: The necessary evil

When it comes to EMRs, big healthcare organizations have a big, nasty problem on their hands. The problem? While they pretty much have to invest in an EMR system to stay competitive, by most IT industry standards this is a lousy time to jump in and do it. At the same time, however, they seem determined to move ahead.

Compared with other types of enterprise IT spending, EMR investments are a major crapshoot at this point, given the lack of support from some clinical staffers and the questions still floating around as to what features they should have. But in this case, providers are facing huge pressure from the federal government, some payers and thanks to ongoing PR efforts, even consumers to bring up an EMR system.

Sure, if they're going to spend the money, now's probably the time, rather than waiting five or ten years for the EMR product category to mature. After all, organizations the size of Kaiser Permanente and Sutter Health--both rolling out the Epic EMR--will spend years integrating such systems into their already formidable infrastructure. So they have to begin getting their hands dirty with the technology now. 

But there's still something odd in how many formidable organizations are choosing to invest  in a product whose feature set is still in question and whose popularity among key users is in doubt. In most industries, billion-dollar enterprises don't get pressured into buying a product this early in its lifecycle and cramming it into their operation. (The closest I can think of is the wave of ERP platform adoptions over the past decade or so--another very expensive boondoggle which only seems to be creating real value after years of heartache and expense.)  

If nothing else, let's admit that the talk about avoidance of medical errors and efficiency improvements is a bit of a smokescreen--because if Kaiser was spending a few billion for that, it'd certainly be losing its shirt for quite some time into the future. While quality is a factor, I'd argue that most execs want to see EMRs in place so they can gather data needed for pay-for-performance incentives and shunt quality and outcomes stats to regulators.

As I see it, if health system leaders, health plans and government officials want EMRs in place so badly, they might want to start by being honest about their motives. Once they do that, they might get clinicians to see EMRs as more than just a necessary evil. - Anne

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