Don’t get sucker punched by delusional thinking when buying an EHR

It’s been a busy week for me hosting executive briefings here at Microsoft for some of our very best hospital and health system customers. These days there is a common theme among many of these organizations. Incentives made available through the federal HITECH Act have healthcare provider organizations making deep investments in new electronic health record solutions. One of the customers I met with this week is on a two-year journey in which they will spend about half a billion dollars on a new EHR for their regional hospital system. In fact, all across America hospitals, clinics, and physician groups are on an EHR spending spree.

imageNow mind you, this is something that needs to be done. It is foundational for moving healthcare into the digital age and is long overdue. However, I worry that some of these organizations are setting themselves up for major disappointment. I can’t tell you how many conversations I’ve had with hospital executives who proclaim with exuberance how they will have transformed their organizations and healthcare delivery itself once the new EHR is in place.

I guess if I was one of those hospital executives (and in fact I was one earlier in my career) and I had convinced my board to spend hundreds of millions or billions of dollars on a new EHR solution, I might also want to believe it was going to transform things in a big way. However, as I’ve stated so many times before here on HealthBlog, that is delusional thinking. The EHR all by itself will transform very little. It simply takes what we used to document on paper and makes it digitally available. Sure, order sets will standardize testing. Some medical errors will be flagged and avoided. Information will be searchable and more readily available. But if you stop investing after the EHR, you’re sunk. It is how you use all that digital information that will make the difference-- how you mine it and measure it to improve quality and cost, how you leverage digital assets to engage your patients; how your clinicians and other staff use technology to communicate and collaborate in new ways; these are the things that will really transform health and healthcare delivery.

That point seems to be getting through. I believe a recent article in HealthcareITNews was spot on with the headline, Growth seen for non-clinical IT in a “post-EHR” world. In the article, Glenn Tobin of the Advisory Board Company tells HealthcareITNews, "I believe we are in a post-EHR world right now. That doesn't mean EHRs are not important. But that does mean that the original promise for which EHRs were rightly pushed out  - we're beyond that. Now we're trying to find the next layer of information systems that's going to tie it all together." He goes on to say,"What we're really talking about is the amount of electronically available information is just skyrocketing on an exponential, very steep part of the exponential curve, but insight that can actually drive behaviors and actions in a population health world, are really, really nascent still – in fact, primitive."

imageimageI agree. The big opportunity in healthcare delivery is to capitalize on all that digital data that exists in the EHR. Hospitals and healthcare systems must now invest in robust analytics solutions to drive real-time and even predictive, deep understanding of their care and business practices. They need to invest in solutions that help clinicians work faster and smarter. They should be looking at ways to streamline how staff communicate and collaborate with each other and their patients. They need to invest in mobile devices and solutions that move with staff and deliver the information they need at the bedside and anywhere else. They should be moving services beyond the walls of the organization and increasingly do so “virtually” with remote monitoring and telemedicine solutions. They must embrace digital and social media. Finally, they need a solid plan for moving information services to the cloud. It no longer makes sense for hospitals to hold all of their data and computing power on premises in what is becoming a cloud first, mobile first world.

I also sense that we are about to enter the next battlefront for the EHR itself. Yet another article that appeared in HealthcareITNews earlier this week seems to bear this out. Athenahealth and Beth Israel Deaconess Medical Center have entered into an agreement to collaborate on what I and executives at Athenahealth and Beth Israel see as the inevitable evolution of the EHR; something that is more nimble, simple, robust and preferably cloud-based. To that I would add, something that is hopefully far less expensive to buy and maintain compared to the majority of solutions on the market today. If we are going to spend hundreds of millions or billions of dollars on something, I’d much rather see it going for what hospitals and health systems are supposed to be doing—taking excellent care of patients.

Bill Crounse, MD        Senior Director, Worldwide Health            Microsoft


Comments (2)
  1. Jerome Carter, MD says:

    Great Post!  

    You state: "They need to invest in solutions that help clinicians work faster and smarter. They should be looking at ways to streamline how staff communicate and collaborate with each other and their patients."    The question is how to provide these features.  

    Current EHR systems were desigend to store and manage patient data, not support clinical work or collaboration (Is the EHR Defunct?…/is-the-electronic-health-record-defunct).   It is time to move from record systems to clinical care systems (…/building-clinical-care-software-systems-part-i-issues-and-challenges)

  2. Jose Fernandez-Engo says:

    Agree. But I think that's a process with two ways deeply entangled (my God, suppose I'm a SOA expert): the evolution of analytic solutions to provide, as you say, a wide and deep on-time vision of clinical care (great Jerome´s sentence) and a deep evolution of the concept of "record" providing a isolation of data from clinical concepts using dual-model and closing the circle clinical concepts -> clinical guides (support to decision) clinical process (continuity of care) -> analytic. So the evolution of clinical paths/concepts/knowledge will not limited by the underlying technology.

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