TECHNOLGY: Too much of a good thing?

Walking the floor at the TEPR show this week brought home the wonders
of electronic medical records. The show had a multitude of
presentations on EMR use, but more than 35 years after the first EMRs
were developed we’re still early in the adoption cycle. Most
presentations were about fairly small-scale case studies. But despite
the exit of hundreds of firms from the EMR and practice management
market, and the slow emergence of several dominant players, there are
still plenty of new entrepreneurial companies with booths — and not
all small ones — out on the exhibit floor. Many of these companies
have new EMR technology that, while it may be more advanced, doesn’t
look that dissimilar to those on show a few years back.  What they lack
is a customer base. But as the legacy players in practice management
and small hospital IT systems have shown, in health care getting into
the market is relatively cheap and you don’t need that big a customer
base to anchor a business.

One of the major problems in physician
adoption of technology is the lack of familiarity with a few trusted
brands, and the insistence on doing everything differently than the
practice or hospital down the street. The sheer number of vendors
willing to support that demand for "doing it different", including
those based on software from physicians who claimed that "what was on
the market didn’t meet their needs", means that we’re a long way from
getting to the status of other industries where everyone is comfortable
with using a few widely known applications.  This might be a case where
we have just too much good old American ingenuity.

Having said that, I saw some interesting products and there are some interesting new developments that I’ll comment on later….

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10 replies »

  1. I am trying to put together a site focused on simplifying IT for especially the small to mid sized medical offcie. You are welcome to go there and post questions and look through the library if you would like.
    The site is:
    It is still being built but with visitors help in addressing the issues we can all help build it together.

  2. I’m an orthopaedic surgeon in my 10th year of practice. My colleagues and I would be thrilled to increase our productivity and revenues, but we need reliable help comprehending IT. Please understand that our minds are focused on the pathophysiology of the individual in our exam room–I certainly didn’t expect to be swept up in this IT thing! (while about 1000 other major policy declarations were begging for my attention.)
    I think there are many parallels between the practice of medicine and IT. Patients are frustrated when doctors use technical jargon, they are just handed a prescription, or they feel rushed into having surgery, etc…I’m working hard to understand the utility and finer points of computers, but I just haven’t been trained to think like you do.
    I’m all for empowering patients to take charge of their health, but please don’t ask the media to “push” me into anything. How about asking interested parties to empower physicians to take charge of our IT? If it really were easy, it would have happened by now.

  3. I also just came back from TEPR 2005 at Salt Lake in UT. It was interesting to see EMR revolution taking place. Doctors teaching Doctors – how they can increase their productivity and and increase their revenues.
    I spoke to several experts, and concluded that if there is any one who can revive the healthcare in this country is, 1. media & consumers together – 2.not the govt or the physicians and or providers.
    Second group is controlled by the lobbyst and the special interest. Consumers need to take charge of their health, and flex their muscles with the second group. Simple logic is that pharmaceutical companies are going directly to consumers with their TV ads to sell prescription drugs directly to consumers. George W Bush is not even touching the healthcare. He has just created a smoke screen between healthcare and social security.
    EMR and healthcare IT sure is a great tool to reduce the cost. Physicians behavior is a challenge. They just do not want to get exposed with their flaws. Consumers along with media will have to push them into it.

  4. Getting back to the “major problems in physician adoption of technology” in the original post: The real obstacle has been the concurrent arrival of crap like HIPAA, predatory shenanigans by the insurance companies, and disintegration of hospital infrastructure that’s diverted our attention. There’s not much energy left to invest in a major transition like EMR.
    Government and profiteers all want a piece of the “healthcare” pie–and they all tried to grab it at the same time. Our practice has been using EMR for almost 2 years, but it’s been a challenge.

  5. “That’s basically the dot com effect isn’t it?
    Somebody has a good idea, and a thousand competitors jump on the old bandwagon offering nearly identical products.”
    That’s business as a whole but I completely agree with your post.

  6. Cerner was one of the final three EMRs considered by Kaiser. I included a bit about it in my CTO Newsletter. I remember the CTO called the article “rumor control” because there was a relatively short period of time between when Halvorson dropped the in-house EMR and when he selected the vendor.
    On the subject of rumors, I knew about Halvorson’s interest in the EMR before anyone the department, including the Director who was responsible for filtering down such information. I read several of Halvorson’s speeches in which he alluded to the importance of an “AMR” (Automated Medical Record – same thing as EMR). I asked the Director of the department what the acronym stood for, and he didn’t know. I found out for myself what the acronmym meant, and then I went back to the Director to let him know what it meant and to ask him what it meant for the department. Since the department consisted of top tier project managers for the NCAL CTO, in theory that department should have been at the forefront of rolling out any AMR. That’s the role the Dept. served for CIS (Kaiser’s in-house AMR, though no one used Halvorson’s new acronym for it yet). Anyway, the Director thought Halvorson was just laying out his ideals: nothing would affect our Dept. Lo and behold, around 6 months later Halvorson made the “sudden” announcement that Kaiser would be writing off CIS and that he was in the process of selecting an AMR vendor. Since CIS was the Uber-Project, all the procect managers in my dept. ran around in a state of stress for a few months. The CTO didn’t help because he was obviously taking big risks in playing hardball about his willingness to commit resources to the AMR.
    Of course, as it turned out the only person who lost their job was me – and that was about the stress my manager was under, not realignment of anything. Transition to CIS became Transition to Epic, and life went on for everyone else.
    Something is tickling way back in the far reaches of my memory: I may know an interesting story. I’ll think about it…

  7. It’s not just the question of whether a necessary public service with theoretically universal standards should be embracing Branding. The technology sector gets away with murder because it claims to be the vanguard of Innovation. Technology workers with no discretionary authority were made exempt employees to protect Innovation. The Internet and new networking technologies have their own arena of law because it’s regarded as a venue for Innovation. Lobbyists swarm Capitol Hill in hopes of scoring fat government handouts for Innovation. Pharma claims all sorts of privilege in the name of Innovation.
    Technology, like health care, should be treated as a utility. Sure innovation improves utilities: thank goodness Edison invented the lightbulb. Yet despite the importance of Innovation in moving civilization forward, at one time the public appreciated that Innovation could still take place while protecting the public interest in standardization and universal access for essential services. And perhaps the term Innovation should be reserved for significant advances that promise to transforn the human condition. Just changing around icons, imposing a new vocabulary on end users, or changing the color of the pill to purple does not constitute Innovation.

  8. That’s basically the dot com effect isn’t it?
    Somebody has a good idea, and a thousand competitors jump on the old bandwagon offering nearly identical products.
    Result: the market is flooded and customers become jaded.
    Too bad there aren’t any economists out there offering theories about what happens when markets become confused and depressed.

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