What Are Users Looking For?
End-users want an easy product that looks and feels like traditional charts.
Doctors want control of who has access to the data and where it is stored.
EHR documents in the US exist as a series of fragments with each hospital’s or doctor’s patient database existing in a proprietary encryption and filing system. While from the individual doctor’s point of view, this should provide them with control and peace of mind; it does not have the interoperability that will drive cost efficiencies or long term viability in mind. Long term viability is an important aspect of any infrastructure project, which is how most hospitals view EHR. Convincing doctors to adopt a single solution is difficult without convincing them that data security and cost concerns will be mitigated. Surveys performed over the last five years suggest a strong bias against allowing control of their life blood by IT or any other outside entity.
Remember, patient records are vital to doctors from a malpractice point of view in addition to patient care. Since malpractice insurance is a large expenditure for doctors (or the hospital in some cases) this aspect of cost control weighs heavily in their decisions. The CIO/IT managers need to understand that the doctors carry a great deal of weight in the decision process today at most hospitals, according to end users interviewed.
The problem is that the vendors’ EHR solutions are not based on what the end-users are asking for or what governmental agencies (e.g. NAS, US HIT program) are outlining as optimal models. The lack of direct compatibility of these solutions with government models reduces the ability of hospital administration to find outside funding for the cost of EHR adoption and maintenance. This combined with the fact that most doctors prefer paper records and older diagnostic machinery, according to interviews with a number of doctors and nurses as well as published surveys.
The majority of current EHR software is not built for back compatibility with these very specific legacy machines thus decreasing any enthusiasm for these products. This coupled with a lack of clear return on investment for EHR, particularly when compared the newest diagnostic machine, means the doctors, who have a great deal of leverage, are not pushing for EHR adoption. Therefore, vendors need to be clear about how their particular solution can minimize costs to doctors in a tangible way. Since many of the EHR documentation and database systems are generally perceived as a new technology, most medical staff are reluctant to endorse or even take the time to understand what they consider a speculative venture. IT managers need to speak directly to the end user with a message that speaks to the reliability and ease-of-use of the software that is being selected.
Why Early Commercial Solutions Are Being Adopted by End Users
The solutions with the highest adoption rates are self-made and have been driven by the physicians and IT departments working together to build the infrastructure and pick the solution from scratch.
Currently, the most successful commercial software solutions fall into one of three different types:
- Integration of multiple real-time devices for acute care (e.g. operating room visuals, medication reminders for scheduling of patient care).
- Horizontal integration of various records (e.g. prescriptions, procedures, diagnostic tests).
- Vertical integration of multiple service places (e.g. emergency room, family practices, orthopedics).
While there are several vendors, each one of them has their benefits and drawbacks.