I heard about this story on Huffington Post from David Kibbe, founding father of the Clinical Groupware Collaborative (CGwC). Here's a quote that struck my eye:
Federal officials won't decide until early next year which types of systems to certify. But some of the world's largest companies, including General Electric, Microsoft, Dell and German-based Siemens Corp., already are working hard to sign up doctors and hospitals.
The potential market is vast: Fewer than one in five of the nation's approximately 600,000 doctors and 5,000 hospitals now use the technology, but by 2015 all are supposed to be keeping their records electronically.
The government's spending, part of the Obama administration's $787 billion economic stimulus, promises to give as much as $44,000 to each doctor to spend on digitizing his or her health records.
"We've got to make sure the products sold are high quality," said Sharona Hoffman, a professor of law and bioethics at Case Western Reserve University School of Law who believes software defects could endanger patients and squander taxpayer dollars.
Elsewhere there was a quote from Jonathan Bertman, a family doc from Rhode Island who has put together a low-priced EMR product I hadn't heard of before: AmazingCharts. The fact that I haven't heard of it is not surprising, given that I have become interested in EMRs for family practice fairly recently, and in the context of clinical research, not market research. Their product page had a quote that sums up concisely my personal view of the EMR/EHR industry:
Most EHRs are ridiculously priced and overwhelmingly complex, requiring servers, intricate networks, and hours upon hours of training which, in essence, are required to re-teach you and your staff how to practice and document the way their confusing program was designed.from www.amazingcharts.com
I should make clear that with my two minutes on their site, I am in no position to pass judgment as to whether the AmazingCharts product actually solves the real problems involved in computerizing health care. In my experience most problems associated with deployment of new IT systems are related to the issues Jonathan Grudin identified back in the early '90's and wrote up in his ACM article, Groupware and social dynamics: Eight challenges for developers. The eight challenges he lists are for the most part social, not technical. Here's a key quote from one of the challenges that also serves as a succinct statement of the core problem:
Groupware may be resisted if it interferes with the subtle and complex social dynamics that are common to groups. The computer is happiest in a world of explicit, concrete information. Central to group activity, however, are social, motivational, political and economic factors that are rarely explicit or stable. Often unconsciously, our actions are guided by social conventions and by our awareness of the personalities and priorities of people around us, knowledge not available to the computer. ...[research has shown] that the social element can be central even to clerical work that seems routine.
The key technical elements in designing a system that can be successfully deployed are user experience design, and in particular user interface and workflow flexibility, extensibility, and adaptability. These are necessary, but not sufficient, components of the deployment process, which inevitably involves some degree of workplace transformation.
The transformation can be highly beneficial, but can only work if the in situ stakeholders are involved in the process, and involved to such a degree that they feel they own the system. This can only occur through intensive communication, both formal and informal, between the vendor, end users, and practice leadership.
With respect to the Huffington Post piece, what is most fascinating to me is the spectrum of comments. I don't have time to go into it now, but one thing is clear: there's a lot of controversy around the Federal initiative to computerize health care, and the controversy is growing.