Tuesday, January 6, 2009

Investing in Mediocrity?

As reported in a recent article in the Boston Globe, David Kibbe, a senior adviser to the American Academy of Family Physicians, and Bruce Klepper, a healthcare market analyst, sent an open letter to our new president-elect, urging caution in the rush to invest in healthcare IT. Describing current systems as "expensive, cumbersome to use, and cannot easily exchange information about patients' health histories and treatments among different hospitals, labs, and doctors' offices. If America's physician practices suddenly rushed to install the systems of their choice, it would only dramatically intensify the [tower of] Babel that already exists."

The rush to deploy current market-leading EHRs is going to lock many healthcare systems into costly and imperfect clinical processes and technology. The functional difference between today's EHRs is minimal; they are rapidly converging on achieving commodity status, as the same old ideas are recirculated through the revolving door of HIMSS and AMIA. These EHRs are a hangover from the paper chart and motivated largely from the historical position of billing compliance and malpractice risk avoidance. They unfortunately perpetuate many of the ills of healthcare, rather than solve them.

We desperately need a revolutionary new approach in the design and functionality of EHRs-- one that is motivated from a position of physician efficiency, quality of care, and patient involvement in their own healthcare management-- with billing compliance and malpractice risk avoidance a natural but transparent consequence. Sinking billions of dollars into the current EHR market will leave no money or free market incentive remaining in the healthcare system to affect the revolutionary change in EHRs that we need. We should tell the EHR vendor market-- those in existence now and those who might emerge if sufficiently prompted--we expect more. As a taxpayer, I would protest major investments or subsidies of government money in the existing EHR market-- such investments would only reward mediocrity. As a healthcare IT professional, I would despair.

We should invest our healthcare IT dollars cautiously and in proven areas of value-- in many physician offices, this could be as simple as computerized registration, scheduling, and billing which improve clinical efficiency; access to wideband Internet services and the emerging lean (and inexpensive) web-based EHRs and PHRs (e.g., Relay Health) which support computerized order entry, especially ePrescribing; and tools that integrate data from existing diagnostic systems into a single user interface for quick reference by busy physicians.

The only thing worse than deploying an EHR is replacing one. Rather than rush headlong into purchasing a mediocre EHR today, we should pause, withhold our funds, and give free market capitalism a chance to react and catch-up to the opportunity by developing a new breed of EHRs which will leapfrog current thinking.

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