Why Has EMR Been So Hard?

I just finished reading Why the healthcare system doesn’t want electronic medical records on Techdirt, and I have to say, I don’t buy it. The article proposes that some vast conspiracy designed to fleece the public through deliberate inefficiencies is at the root of the push back against going digital.

I’ve spent a more than dozen years now in various places within the healthcare landscape and I can tell you we’re not organized and coordinated enough to pull something like that off.

In all seriousness though, the problem is very real. But it just doesn’t derive from anything so pernicious as a raw profit motive.  It’s much more about misalignment of incentives.  Let’s look at this in a different way:

  • This healthcare “system” of which you speak — it doesn’t exist (except in a small number of cases and markets)
  • Hospitals have, for the most part, adopted electronic records. Those that are large enough have the kinds of inefficiencies that make such a decision easier.

The push back has come more from the physician community, so let’s look at why that is:

  • We’ve largely asked the physicians to pick up the costs of these systems for their practices
  • In many cases, they make the physician less efficient
  • Other places in the system (the insurers, for example) see more of the benefit
  • No one has reimbursed them for the trouble

Given, this isn’t as true now as it was in the past.  So what’s still standing in the way?

  • The long-term goal of electronic records isn’t storing the data electronically, rather it’s to change the way that physicians practice medicine

This is the concern. Doctors value their autonomy. They didn’t spend all those years in medical school so that some kid in IT could tell them how to practice medicine.

You don’t think so? What do you think evidence-based medicine and pay for performance are all about? They dictate how doctors should treat patients.  None of that can work without a system that captures data, delivers direction and allows for reporting for accountability.

When you look at the disparities in the way patients are treated from doctor to doctor and state to state it becomes obvious that this is the inevitable direction.

So why are we looking at a growing list of financial incentives to go electronic? Why should that be necessary to do what seems obvious from the start?

The reason is that no one gives up control willingly unless someone makes it worthwhile for them. As that reality has been accepted, the tools have begun to fall into place to make that happen.

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Ben Dillon

About Ben Dillon

Ben’s a big picture type of guy. He loves sharing new ideas in digital marketing, keeping a watchful eye on healthcare industry trends and seeing how it all intersects. A sought-after speaker, writer, blogger and current SHSMD board member, Ben’s an influential voice in healthcare marketing, helping organizations across the country embrace online strategies to engage health consumers. Combine his industry savvy with his background in software development and you can see why he’s also an important member of Geonetric’s software team, ensuring our content management system stays a step ahead of market needs. Ben holds a master’s degree in eBusiness and strategic management from the University of Iowa and a bachelor’s degree in computer engineering from the University of Michigan. When he’s not traveling and evangelizing, Ben enjoys cooking with his family and playing the Big House with the University of Michigan Alumni marching band.

2 thoughts on “Why Has EMR Been So Hard?

  1. Just to clarify, we were NOT saying a “vast conspiracy.” Not even close. We were saying the *overall* incentives are set up this way. It’s not a conspiracy. It’s everyone acting perfectly legally and properly. But the incentives drive such a result.

  2. My apologies. “Vast conspiracy” is my words. You referred to it as “…the entire scam of the healthcare system”.

    I’m saying that I believe you are wrong. I don’t think that the idea that electronic records would expose “the entire scam” is simply not correct.

    I agree that misaligned incentives are very central though. I just don’t think the resistance to electronic medical records comes from a desire to deliver frivolous services or practice reactive medicine. Doctors don’t believe that they will receive benefits that justify the costs and pain of implementing.

    Further, EMR doesn’t cause proactive medicine to happen. Many organizations have these technologies today, but they aren’t necessarily focusing on preventive care any more than those on paper.

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