Why don’t more physicians use EMRs? Critics are quick too point out current
systems are work flow nightmares for many physicians. But if that is true, it raises the
question how did we miss this target by a mile?
If systems developers did not have any physicians on staff I could readily
understand. But virtually every vendor I know that is of any size has several. Some
like Cerner, NexGen, Epic, GE, and McKesson have maybe hundreds. Some MDs I
know personally keep a small practice on the side just to stay up to date on
protocols, processes, etc.
What have these vendor MDs been doing over the last decade? I guess ignoring IT
and doing a lousy job?
I doubt it. We know that the work flows from an orthopod to a psych doc are very
different, and at that general level I believe the developers have addressed many of
the differences quite well. So it must be that from one orthopod to the next orthopod,
or one psych doc to the next, there is even more variation. Sometimes it simply
depends on which medical school / residency they attended.
EMR critics contend that a system must follow the clinician's work flow, and it must
of course be affordable. In keeping with these suggestions, it seems to me that what
we need is a 'virtual custom' system built with components like powerful user defined
presentation tools, flexible work flow definition and management tools, and
extremely flexible output tools. With all these tools accessible at the user level so we
can make the system 'just right for me'. Given today's advanced programming
technologies it can be done.
But there is a cost for all this high power flexibility. Such as:
1. Giving users high power tools cost more (usually they may get a stripped down
run time only version, - think Crystal Reports)
2. Users need to be trained on these tools, the more powerful they are the more
time it will take. Training on power tools can go well beyond the hours budgeted
for the core application. Think orders of magnitude.
3. Installation and setup will require at least twice the time because now we have
to document the current processes, make adjustments, then use the power
tools to initialize the system according to 'our best practices'. Note the
operative word 'our'.
4. Power tools require at least one power user, and they do not come cheap.
On the other hand if we were willing to accept industry best practices as the
core work flow, after the first install, and some minor changes we could just load
Oh, but I forgot what we really need is a low cost 'custom' system. Back to the
The Kelzon Group