So It Turns Out Inventing Your Own Business Model Is More Fun Than You Were Expecting…

It’s official.  The road sign clearly welcomed me here.  I guess all business start-ups have to go through this town (Hell).

What?  No bravado?  No chest pounding about how my ideas will change health care while making patients smell as springtime fresh?  Nope.  None of that.  It’s hard to get excited about ideas when only money pays the bills.

Having now left the safe confines of my leftover earnings from my old practice, I am now supposed to be self-supporting.  Two big things have caused this to not go as smoothly as I have planned:

  1. My construction took twice as long as I expected.
  2. I have yet to find a computer system that doesn’t make me want to pound on my desk and wantonly overuse the word “inconceivable.”

A month behind on beginning to earn money hurts a lot, as does the extra cost of construction, but the computer problem has me beyond frustrated.  Why do they make medical records in which:

  • Neither I nor my nurse could figure out how to put in vital signs
  • You can’t print out a letter with lab results
  • You can’t enter a “historic” or “handwritten” prescription to document it was given
  • There is no flowsheet in which to enter lab results (we are 4 for 4 on that one)
  • There is no way to attach external documents
  • There is no marital status of “single,” but there is “polygamous”?

I guess I am just a perfectionist, expecting everything from a record, but why do I have to settle for an EMR by choosing the one that is “the least aggravating?”  But this is what I’ve had to do, and today I was entering data and getting distracted by my frustration, thinking bad thoughts about software engineers and fantasizing about building my own system?  Before anyone tells me I should do just that, let me point out three things:

  1. I don’t have the time.
  2. I don’t have the money.
  3. When feeling insecure about how I run one business, the solution isn’t to add another new business.

So this is hell.  I am doing my best to be satisfied with my “minimum viable product,” meaning that I am satisfied with putting out care that my patients are happy about (which they are) even if I am frustrated with the process of giving that care.  I need to grow, but the computers are making it very difficult.  I’ve had lots of suggestions thrown my direction, ideas of how I may solve my problem.  It’s probably just going to take time.  I am learning patience.  I am learning humility.  I will be stronger for the lessons I am learning.

I’ve even considered trying to raise money as a “health care start-up.”  I’ve looked into small business incubators (although, being in Hell, the idea of an incubator isn’t that appealing).  I could have people buy bricks.  I could sell autographed pictures of llamas (although I’d have to find a llama who can write first).  I could engrave the name of supporters on my “humongous handicap ramp of awesomeness.”


I’m waiting for the Riders of Rohan to appear on the hill, but so far they haven’t come.

Come on, Theoden.  I’m counting on you.  I just hope you’re not a software engineer.

Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at More Musings (of a Distractible Kind),where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player. He is a primary care physician.

12 replies »

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  2. I am not a software engineer. I do feel your pain. The software our company adopted for her does not even generate excuse notes for patients. Since adopting EMR we use 5 times the amount of paper prior to adopting.

  3. I am a long-time GE user, actually, and some of my frustration may stem from the fact that my vision of an EMR was shaped by Mark Leavitt and his gang. But I was frustrated with the direction GE was going (more difficult to use and more geared toward compliance, away from care). I suppose the devil you know is better than the one you dont….
    I am still trying to figure out what the deal is with the other systems I am looking at and why they don’t do basic things. Finding this out is harder than expected.

  4. Following your story closely. Sitting here on the EMR helpdesk I can’t help but think that my product (GE) can offer all the things you are frustrated with. I’ll be honest, though and admit that it woudl come with a host of new and exciting frustration, and I’ve been following long enough to know that your list above is not exhaustive. but those seem pretty basic! No flowsheet to enter labs!!? come on!

    I have to ask : is the EMR really that big a turd? did you call support about these features and did they really tell you ‘no way’?

    You should start name dropping. I am very interested to hear the good the bad and the ugly of the specific products you’ve been working with. I would also be interested in hearing about your support experience with vendors and vars. You’re by far my favorite Healthcare IT blogger, Rob. Keep up the good content! =)

  5. As a Tolkien geek, your reference to the charge of the Rohrimm at the Battle of Pelenor Fields is awesome! Maybe you need more beacons?

  6. EMRs are no longer, if they ever were, designed to aid physicians in taking care of patients.

    The sooner you can accept this fact, the less frustration you’ll experience.

  7. Remain strong, Dr. Lambert. Lots of people are rooting for you.
    Besides, you’ve gone too far to turn back now.
    I know you can do it.

  8. The first few sentences refer to a road sign welcoming me to hell. Just clarifying things.