The Perfect EHR

I support over 3000 clinicians in heterogeneous sites of care – solo practitioners, small offices, multi-specialty facilities, community hospitals, academic medical centers, and large group practices.

In every location there is some level of dissatisfaction with their EHR.   Complaints about usability, speed of documentation, training, performance, and personalization limitations are typical.   Most interesting is that users believe the grass will be greener by selecting another EHR.

I’ve heard from GE users who want Allscripts, eClinicalworks users who want Epic, Allscripts users who want AthenaHealth, and NextGen users who want eClinicalWorks.

The bottom line from every product I’ve used and everyone I’ve spoken with is that there is no current “perfect” EHR.   We’re still very early in the EHR maturity lifecycle.

What is the perfect EHR?   I’ve written about my best thinking, which has been incorporated into the BIDMC home built record, webOMR.   (and has dissatisfied users too)

However, after listening to many “grass is greener” stories, I believe that what a provider perceives as a better EHR often represents trade offs in functionality.  One EHR may have better prescribing functionality while another has better letters, another is more integrated and another has better support.  The “best” EHRs, according to providers, varies by what is most important to that individual provider/practice, which may not be consistent with enterprise goals or the needs of an Accountable Care Organization.

My experience is that organizations which have given clinicians complete freedom of EHR choice now have an unintegrated melange of different products that make care standardization impossible.

My advice – pick an EHR for your enterprise that meets your strategic goals, providing the greatest good for the greatest number.   Apply a maximum effort to training, education, sharing of lessons learned, user engagement, and healthcare information exchange.

There will always be dissatisfaction and a claim that something is better.   However, I’ve never seen a change in product fix workflow and process issues.    BIDMC’s strategy is to do our best  to ensure providers are educated and use their EHR optimally.   I do not believe that there is a better choice than our current mix of built and bought products that makes sense for our pioneer ACO and individual providers within the organization.

John D. Halamka, MD, MS, is Chief Information Officer of Beth Israel Deaconess Medical Center, Chief Information Officer at Harvard Medical School, Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the HIT Standards Committee, a full Professor at Harvard Medical School, and a practicing Emergency Physician. He’s also the author of the popular Life as a Healthcare CIO blog.

2 replies »

  1. Rajesh, I agree with your comments. It is also important to have a technology solution that can survive in the healthcare environment and withstand a day of rounds. Not all tablet or laptop devices are equal and one such proven device is the Panasonic Toughbook. I think the device is a important part of this mix.

  2. As someone who has experienced many EHR systems (often in the same day), I can attest that there is no perfect EHR out there. Not even close. Some products and implementations of products seem better than others (in terms of having the required functionality, ease of use, intuitiveness, etc.) than others, but I’ve yet to use one that I consider even “good”.

    Clinicians must often use multiple systems (and/or modules) with radically different user interfaces each day. It gets confusing, especially when screens are organized differently and icons and colors mean different things across the different EHR systems and implementations.

    The sooner that we empower EHR users with a “personal” user interface that works across all of the products that they use, the sooner that we’ll solve the problem of poor EHR design and one-size fits all trade-offs.

    Give clinicians (and patients) a consistent, personally configurable way to access (and customize) the ways that they interact with health IT systems.

    This will also open a market for specialty-specific screen lay-outs, data entry / documentation and data visualization “plugs-ins” and apps that work across products.

    Of course, de-coupling user interfaces from EHRs would disintermediate the EHR industry, free resources and refocus competition on say, data interoperability, customer services or other areas of current deficiency.

    All I know is that the status quo is painful for actual users. Does anyone really think that EHR vendors are really going to spend resources to improve their current usability? Or that the same industry that developed bad PC-based EHR UIs develop bad UIs for mobile devices?