The first commercial EHR applications started to appear on the scene in the early 1990's. Fast forward to 2004, when then President Bush declared in his State of the Union address that electronic health records (EHR) would be universally implemented by 2014, and established by Executive Order the position of National Coordinator for Health Information Technology to start the ball rolling. Four years later President Obama helped to put teeth into that plan through the American Recovery and Reinvestment Act of 2009, by providing $17 billion in direct incentives to physicians to adopt the technology, and basically maintaining the same time frame as his predecessor. So, why now? One reason: the technology is finally ready.
Like many pioneers, the first physicians to implement EHR's blazed the trail at their own peril, frequently taking "arrows" in the process. Those first generation EHR's (which were at that time only EMR's) were clunky, difficult to navigate, and cost the physicians more time rather than less. They took hundreds of hours of training and configuration, and each additional change thereafter required an expert, rendering the ongoing maintenance and training to be nearly cost prohibitive.
Along came the second generation of product, and while better than the first, they were still clunky and expensive. They continued to require a high level of expertise, although many EHR vendors began to provide less training as part of the package, capitulating to physician demands for lower costs in an attempt to broaden the market. Unfortunately, by not also making the product fundamentally better and more intuitive, they instead undersold the training and implementation in an effort to "mass market" that which was still an early stage product. This resulted in many dissatisfied physicians as they got the worst of both worlds – clunky software requiring expertise, but little accompanying expertise.
More recently, a handful of progressive vendors have led the way to develop a third generation of EHR software. Built on newer technology platforms and with lessons learned from the first two generations of legacy software, this 3G software is much more intuitive, actually does speed up the process for physicians, provides a safer and more convenient patient encounter, and requires significantly less training and setup time.
Unfortunately, some of these same 3G products are being sold as "out of the box," making the same mistake as the 2G legacy vendors made, and underselling the critical component of training and custom implementation. Although 3G products do require LESS training than did their predecessors, it is disingenuous to suggest that anyone can change the entire way medicine is practiced with only one week's worth of training by a team who knows little about the nuances of that particular practice – or worse yet, over the phone. Locally based training and implementation is now even more critical, not less. The quality 3G products that include adequate amounts of training and custom practice setup are now at a price point that can easily be cost-justified … even without the thousands of dollars in stimulus funding.
I often equate the current EHR software scenario to the development of the automobile. When the Model T first came out, it broke down every few miles and required the driver to have a detailed working knowledge of his or her car in order to make it work. Yet it was still more efficient than the horse and buggy it replaced. However, we have now progressed to the point that if we were asked to drive a car today that broke down every few miles we simply would not accept it. Similarly, the early pioneers of EMR software found that even with clunky software, those that did put in a real effort could achieve an acceptable ROI. But for those who are just now getting their license to "drive," they will be pleasantly surprised to find that there are a number of new models out there that don't require them to ever lift the hood, while quickly and efficiently traversing the new landscape – provided they don't skimp on training and customization, i.e., they get the appropriate amount of "driver's education."
Why now? Here are the top 10 reasons:
- 3G EHR software technology
- Improved patient safety
- Improved physician productivity
- Improved staff productivity
- Dramatically improved patient (customer) satisfaction
- Enhanced patient security
- Cost point that makes immediate ROI possible
- E-Prescribe initiative incentives
- PQRI incentives
- Stimulus Plan that more than covers the cost
David Schlaifer is president of Doctors' Administrative Solutions.Doctors' Administrative Solutions (DAS) provides people-based technology solutions for physician practices through electronic health records (EHR) and related products, services, training, and the creation of a connected healthcare community. DAS changes the paradigm through a holistic approach that focuses on people and process along with technology, including on-site training and implementation, local customer support, and Total Cost of Ownership program that eliminates the hidden expenses associated with EHR deployment and continuing use. Reach DAS at info@Dr-Solutions.com or www.Dr-Solutions.com