After this many years of widespread use, you’d think that physicians would have accepted that EMRs are an inevitable part of practicing medicine — and at least sometimes, a useful tool that helps doctors manage their panel of patients more effectively. But it seems some hospital administrators have concluded that a significant percentage of doctors loathe EMRs.
I draw this conclusion not from casual conversation with physicians, but from a hospital recruiting advertisement quoted in The New York Times. The advertisement, which was attempting to attract doctors to a facility in Phoenix, closed its glowing description of state-of-the-art equipment and an attractive location with a single provocative line, all in bold: “No E.M.R.s.”
While EMRs are getting long in the tooth these days, they haven’t won over many doctors. As physician Robert Wachter notes in his NYT piece on the subject, a 2013 RAND survey found physicians most unhappy with EMRs, citing “poor usability, time-consuming data entry, needless alerts and poor work flows.”
I think it’s pretty obvious why EMRs continue to stay user-hostile. While doctors are the end users of EMRs, hospital IT leaders and other CXOs make the final buying decisions. And he (or she) who writes the check makes the rules.
In theory, it’s strongly in hospital management’s interests to force EMR vendors to clean up their usability act. After all, not only do hospital leaders want their EMRs used effectively, they want the data to be robust enough to be usable for value-based care delivery. But the truth is that hospital leaders are nowhere near demanding enough of EMR vendors. And because they’re the ones writing the checks, doctors get stuck with the ugly results.
But what if there was a way to involve both doctors and hospitals financially, as partners, in buying EMRs? Not being the world’s greatest finance wizard, I don’t know how a hospital and a group of physicians could structure a deal that would allow them to jointly own the hospital’s EMR system. And I’m aware, though I don’t know how they would be addressed, that there could be significant legal issues to be resolved if the hospital was a not-for-profit entity.
But at least in theory, if doctors were paying for a percentage of the EMR, they’d have a lot more say as to what level of usability they’d demand, what features were most important to them, and what price they’d be willing to pay for the system. In other words, if doctors had skin in the game, it would put a great deal of pressure on vendors to make EMRs doctors actually liked.
Now, I realize that doctors might have no interest in buying into a technology which has let them down again and again. But there’s a chance that more visionary and tech-friendly physicians might grab the chance to have a substantial say in the EMR-buying process. The idea is worth a look.