Yes, this blog covers hospital EMRs/EHRs. And have no doubt, I understand the many reasons hospitals continue to invest in such systems, sometimes accomplishing important clinical goals in the process.
Still, in many ways EMRs are still undiscovered country. After all, the hospital industry still hasn’t adjusted to EMR/EHR use, though a few early adopters are well on their way. And it never hurts to take a skeptical look at a trend barreling towards the industry at such speed. So here’s my “devil’s advocate” take on EMR/EHR adoption by hospitals, below. Honestly, I think we’ve paid too little attention to the rather basic argument below, so let’s dig in a bit.
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So, you think it’s a given that hospitals need to roll out EMRs? Well, I’m not so sure — and let’s admit it, you probably aren’t either. If you think I’m going overboard, fine. But I encourage you to read the following before you make up your mind. Here’s three reasons hospital EMRs are a bad investment, at least at the moment:
* They’re incredibly expensive, yet offer no obvious short-term ROI.
Let’s start with the most obvious issue — cost. From the tens of millions laid out by mid-sized community hospitals to the alleged $4+ billion Kaiser Permanente spent on its giant Epic installation, hospitals are spending a huge chunk of their IT budgets on EMR rollouts. In most cases, they’re forcing the staff to work on overdrive to meet Meaningful Use goals, and pulling people off of other worthy projects. All this for systems which aren’t likely to mature for, oh, three to five years into their adoption cycle. And when will hospitals see the ROI on their investment? OK, everyone agrees EMRs will save money someday — someday! — but I’m still waiting to see a dollars-and-cents ROI estimate. Has anyone seen one?
* They’re taking the place of other efforts offering a more direct impact on patient care.
What else might hospital IT departments do with the gigabucks they’re spending on EMRs? Where do I begin? Advanced telemedicine and mobile care options. Improved devices for managing care at the bedside. Better nurse to nurse communications options. Or even laying long-term plans for health information exchanges. If hospitals weren’t pushing so hard to digitize patient records, they might change care for the better right away. Certainly, EMRs can add something to all of these efforts, but the truth is that they’ll stay in 23rd place on the list as long as the IT department is focused on the EMR installation.
* Hospital EMRs are still clumsy to use and hated by many — if not most — physicians.
I admit, many industries are forced to adopt a key piece of software before it’s completely mature. Heaven knows many manufacturers were more or less forced to spend enormous sums on an ERP install, only to have to patch, adjust and integrate for years before they had a workable system in place. In this case, though, does the hospital industry really need to do this? I know government officials and policy wonks are convinced that hospitals should just, in effect, suck it up and do the install. And I know that someday,we’ll need to put a fully-linked, national data network in place that links hospitals to other providers, something that won’t work without EMRs at its core. But isn’t this premature? From what I’ve heard, most hospital EMRs are ungodly awkward to use, extremely difficult to integrate with other systems and counter-intuitive to use. (They’re pretty much a turnoff all around.) Why not wait until we have better standards in place for UIs, components, data networking and the like? Plunging ahead with a massive national EMR push just doesn’t make sense yet.
Yes, I know nothing I’ve said here is terribly original — but that’s what surprises me. If everyone knows all of this, why hasn’t the big EMR march screeched to a halt?
I can understand some of these negative arguments. I recently made the switch from paper to electronic, and I don’t regret it at all. I have learned that it is important to find a company that will guide both you and your staff members through the change. I chose a small company called TNEHR and I would recommend them to any doctor who is wanting to make the switch.
My goodness. How could you write a post like this without mentioning meaningful use? MU gives powerful incentives for adopting EMR (and soon, disincentives for not adopting).
Also, search pubmed for papers on ROI for EMR, — there are dozens, and I helped write one about our ED system. The ROI is not always “short term” but it’s there, within 8 months in our case. http://1.usa.gov/oOxOCt
You do have a point about consuming IT resources, but some of the examples you choose: telemedicine, HIE, make no sense without electronic records. Do you want a health information exchange where people search for scanned PDFs of charts? And while I think HIE and telemedicine can occasionally have a big impact on a few patients’ care, do you really think that will trump the daily impact of EMR, and the decision support, error-checking, and record retrieval that go with it?
As for EMRs being clunky and unloved and immature, well, you’re right. They were clunky 10-15 years ago, when AMIA and others were recommending a hands-off approach from government, to avoid stifling innovation. Yet EMRs are still clunky today. Maybe incentivizing widespread adoption will spur some changes — waiting for the marketplace to improve itself really hasn’t helped.
Katherine you write: “Yes, I know nothing I’ve said here is terribly original — but that’s what surprises me. If everyone knows all of this, why hasn’t the big EMR march screeched to a halt?”
Very interesting question. If what you say is true, the Docs aren’t pushing for what is happening and the business folks don’t seem to care if it costs more than it saves.
Maybe it is an ideological thing?
Maybe it provides jobs, vendor business, and empire building opportunities.
Maybe its the control aspect, and not the cost savings or patient care improvements that purchasers of EMRs care about.
In other words, who benefits if the docs, patients and the hospital bottom line don’t benefit?
As a physician & CMIO, I can say that “bad investment” is way too harsh … and “risky investment” may be more accurate.
The push to EMR is an important part of 21st century medicine … but like everything else the government mandates, the process is premature and has been poorly thought out.
We have allowed EMR/EHR vendors to ignore standards, workflows, and even clinical evidence. We blame the clinicians for resisting technology that in no way resembles the way that they practice or think.
Even worse, EMR/EHR vendors maintain a “hold harmless” status, leaving the clinician to adjust to poorly designed products in a world with full medical-legal exposure and diminishing reimbursement.
It is little wonder why this has been a struggle. As a CMIO, I must overcome
As stated by another above, MU is large part of this. The idea that something isn’t broken or that it is working fine the way it is lets not try to make it better or safer is a mentality that has American jobs going overseas. ROI cannot be the only reason for making an investment, if so think about the one malpractice suit that can occur that couldve been avoided with an EMR. Its not the easiest to implement and there is a significant change associated, but do you really want better technology avaibable at your local mechanic or McDonalds than what is available at your hospital? That is what it amounts to, technology in aiding the jobs of healthcare providers so that they can treat the patient at a higher level is why change is needed.
benefits investments…
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