Intelligent Healthcare Information Integration 8/22/09

The Over/Under of EHRs

If you be a betting man or woman, you know the over/under is a wager made relative to some predicted number or stat for a given game, series, team, or player. The bettor guesses whether the actual result will be higher or lower than the predicted number, wagering accordingly. The classic example is the combined score for a particular game, say a football game, where the bookmaker predicts the combined final score for both teams and gamblers ante up on either a higher or lower alternative. (Just one of so many great ways to bet your booty away!)

While considering an Over/Under for EHRs, I realized that many EHR vendors have an entirely unrelated set of “overs” and “unders.” Thus, the Over/Under of EHRs:

• Overpromising: EHR sales folks are known far and wide for promising that their system will not only meet your every EHR need, it’ll clean your windows and some will reportedly make toast.
• Underdelivering: Many EHR end users have dirty windows and their bread grows mold waiting for the heat.
• Overcrowding: Crowdsourcing is a powerhouse for innovation and development, best by invitation, not demand. It is not a replacement for first solidifying a product for an optimal end user experience. For EHRs, it should be used to create finesse, not rework clumsy development.
• Underdeveloping: See “Overcrowding.”
• Overestimating: The real pace of “go live” for many practices is far slower and the time to “fully live” often far longer than vendor rep guesstimates.
• Underestimating: Tech heads think their in-depth understanding of the geek world somehow elevates them above the lowly techno-illiterati. The illiterate can learn; the arrogant will find humility a much steeper learning curve.
• Overasking: EHRcos, break your molds! Stop asking only each other what works. Ask outside your boxes.
• Underasking: Don’t EHR developers want to know what motivates and inspires the not-yet-adopted, their largest market target? While it’s always easier to ask those who speak your language, it doesn’t always lead to the insights of “cross-culturalism.” Talk to non-users, not just the techheads. (Also, see “Overasking.”)
• Overextending: More installs means more profit, regardless of the actual support personnel per user ratio. VC pressure may often have a role.
• Undersupporting: Take a lesson, EHRcos: Call Godaddy.com support. Bob Parsons may be rather sexist and not everyone’s cup of tea, but the man understands how to take care of customers.
• Overcharging: Just as so many gripe over the excesses siphoned from our healthcare dollars by insurance company middlemen, many EHRcos seem bent upon oversucking the same marrow.
• Undereducating: With all the grand tools available for training these days (live web conferences, “easy bake” high def video creation, eReaders, etc.,) it amazes me how many providers will agree to a week or two of onsite “education” for something as complex as total workflow redefinition.

OK, time to play bookmaker. Using the 80/20 Rule, if we say 80% full adoption of 80% of available digital utensils, I’ll propose (somewhat from my hiney) the Over/Under for EHRs: 2015. Ladies and gentlemen, place your bets.

I think that only daring speculation can lead us further and not accumulation of facts. – Albert Einstein

Dr. Gregg Alexander is a grunt-in-the-trenches pediatrician and geek. His personal manifesto home page…er..blog…yeh, that’s it, his blog – and he – can be reached through http://madisonpediatric.com or doc@madisonpediatric.com.