Is your electronic health record (EHR) too expensive, slow and inflexible? Is it painful to use? If it is, have a look at Extormity, and then perhaps you’ll feel a little better. Extomity’s tagline is “Expensive, Exasperating, Exhausting.” Extormity is certified by SEEDIE, the Society for Exorbitantly Expensive and Difficult to Implement EHR’s. After looking at the site, you’ll at least get a good laugh out of the spoof on the worst of the EHR industry today.
The Extormity gag was taken a step further at HIMSS 2011 with an actual interview with the CEO of Extormity. Full of excellent lines like “We store sensitive patient data on old 8-tracks, no one ever steals REO Speedwagon 8-tracks” and “We’re a Manackled® patient portal. If you like tethered portals, you’re going to love Manackled® portals.”
We all laugh because we’ve all seen little bits of this in the real world of EHR vendors. What Extormity isn’t hitting on is the very real question – are EHRs improving care and outcomes as they’re implemented today?
A recent Stanford study concluded the following:
“A team from Stanford University in California analyzed nationwide survey data from more than 250,000 visits to physicians’ offices and other outpatient settings between 2005 and 2007. They found electronic health records did little to improve quality, even when there was ‘decision support’ software that gives doctors tips on how best to treat individual patients.”
There are a number of individual facilities that have demonstrated dramatic improvements in quality that they attribute to their EHRs. Big players in the healthcare space including Kathleen Sebelius, Secretary of Health and Human Services, and David Blumenthal, National Coordinator for Health Information Technology, have been pushing the message in speeches regularly that EMRs improve quality.
There are also a great many “maybe ifs.” In the past, the biggest of these was “Maybe if these EHRs have decision support,” but this study undermines that idea. Here are some other “Maybe ifs” that are floating out there today:
- Maybe if we looked at the secondary uses of the EHR data, outcomes could improve and costs could go down
- Maybe if they looked at more current information, outcomes could improve and costs could go down, certainly the technology has improved since 2007
- Maybe if some of the decision support systems were smarter, outcomes could improve and costs could go down
I don’t buy it.
Here are my “Maybe ifs”:
- Maybe if we changed the way healthcare was practiced, outcomes could improve and costs could go down
- Maybe if we changed patient behaviors, outcomes could improve and costs could go down
In my experience, automating inefficient manual processes only improves things in a small number of scenarios. It doesn’t work in patient care. Patients aren’t getting more or better information from providers. Providers routinely ignore recommendations from decision support systems. Doctors don’t need to chase down the paper chart. But other than that, very little has changed.
Those organizations that are delivering noticeably different results aren’t doing so because they have an EHR. They’re doing so because, at least in part, the information technology is enabling meaningful change in the way that they deliver care.
But even that doesn’t matter a great deal if patients don’t change their behavior. Are they staying healthy? Getting preventative screenings? Following their physician’s directions when they leave the office? If they don’t get up and move, lose weight, eat well, stop smoking, take their medication and go to the physical therapist, outcomes will continue to be mediocre.
Let’s face it, patient behavior isn’t going to change when they only see their care provider once or twice a year. It’s going to require more connection, engagement, counseling and coaching to make that happen. That’s a big shift in the way that care happens.
After all, if your plan isn’t to do things in a better way, then you may as well install Extormity.