Why Do Most Current EHRs Suck? How to Fix? Hint: Workflow!

Yesterday I was quoted in Healthcare IT News. (Thank you!) I was asked three questions. Are EHRs getting better? What would make them better? Would physicians prefer to go back to paper medical records? My answer to the first question was quoted. For the record, I herein include my answers to all three questions.

My questions:

1. In your view, are EHRs getting better? If yes, how? If no, why not?

(Quoted in Doctors Demand Extreme EHR Makeover … Right Now)

Yes, EHRs are getting better, but not fast enough and there are fundamental limits to how much they can be improved. The workflow of even workflow-oblivious systems can be tweaked and made marginally better. However, at some point, the effort and cost of straining toward more automatic, transparent, and flexible workflow within systems not specifically designed to make that possible, will be greater than the resulting improvements.

2. What would make EHRs better?

A time machine? To go back and design EHRs on top of workflow platforms instead of database platforms? Current EHR technology is essentially “pinned”, by the combined legacy of Meaningful Use and current MACRA incentive-driven mandates. Healthcare’s boil-the-ocean approach to healthcare data and physician micromanagement needs to stop. Stop directly incenting outcome measures. By all means measure outcomes. But, to paraphrase Goodhart’s Law (please Google it), “When a measure becomes a target, it ceases to be a good measure.”

We are unfortunately quite limited in our ability to improve the current installed base of EHRs. Instead, we need to implement a new layer of workflow technology atop the current existing layer of workflow-oblivious databases with lousy user interfaces. This is happening. Every year I search every website of every HIMSS conference exhibitor. I’ve seen workflow thinking and workflow technology essentially go from almost non-existence to large minority of vendors. Technologies not called Electronic Health Records will increasingly encroach on the original vision of EHRs, and supply the seamless and intelligent workflow current EHRs cannot deliver.

3. I know docs had to document before EHRs came along (remember all those manila folders?). Was that easier?

Your bipartite timeline should be a tripartite timeline:

1. Pre-EHR
2. EHR pre-MU
3. EHR post MU

Most physicians today would not go back to pre-EHR days. However, many who had EHRs before MU, would definitely go back to pre-MU days. Those physicians and hospitals loved their EHRs. Medical centers who self-developed their EHRs had staff who loved their EHRs. In the ambulatory medical practice world, some physicians wrote personal checks for their EHRs. They wouldn’t have done so if their EHRs sucked. After MU came along, EHR user satisfaction dropped. In many cases, EHRs that were designed pre-MU, and originally had high user satisfaction, were redesigned to obtain MU subsidies. Subsequently user satisfaction dropped.

Thank you! I’m eager to see your answers.

You are welcome! Viva la workflow! Onward Workflowistas!

Leave a Reply

Your email address will not be published. Required fields are marked *