Early in my career, I worked in environments in healthcare, both Inpatient and Outpatient, that would come to be labeled as “Early Adopter” spaces with regards to the Electronic Health Record. The first year that I worked for an EHR vendor, every client I came in contact with was transitioning from paper to an electronic system. The majority of physicians (and most clinicians and staff) pushed back on such technology, defending themselves with the “what isn’t broke…” argument. The spectrum of emotions during implementation of such technology ran the gamut from apathy to anger. As consultative and project management-driven as my role was, I consistently found myself in a position of “selling” end-users on the value of the EHR to their patient care and themselves.
That was a different time. Over the course of the last decade, the dynamics of healthcare have shifted dramatically, arguably most notably with regards to information technology and the EHR. Where once I had been coaching a physician on how to type on a computer, I now find I am consistently explaining why “x” vendor does not have iPad-friendly features. Beyond peer pressure or the notion of accepting the inevitable, one might ponder what led to such a dramatic shift in a relatively short amount of time.
From my vantage point, there are several reasons for this. Meaningful Use and the stimulus technology implementation/use dollars ignited a surge in adoption of EHRs, especially in the outpatient clinic environment (representing the majority of the “late adopter” EHR consumers.) There was a scramble, dating back to 2010, to adopt technology that was “approved” in the healthcare space, in order to begin collecting the government incentives. Yet, despite the fast and furious adoption and subsequent immediate financial gains, I have witnessed that physicians have noted a loss of overall revenue as well as decreased practice satisfaction nonetheless.
This should not come as a surprise. Many practices, eager to attain their promised stimulus money, chose their EHR vendors based on word of mouth, vendor pressures, and industry marketing, rather than performing imperative due diligence during the selection process. Interestingly, I have witnessed a new trend in HIT as a result. Instead of settling for a less than ideal solution in an EHR, the majority of practices that chose a less than ideal vendor partner have elected to “rip and replace.” Specifically, many clinic owners have elected to consider different/new vendor providers that offer more precise and appropriate solutions for their businesses, rather than settle for a subpar solution just because it enabled them to access immediate financial incentives. Even as the second stage of Meaningful Use comes to a close, physicians seem to be coming to the realization that the opportunity cost of selecting the less than adequate technology far surpasses the government carrot dangled in front of them. They are not wrong.
The reason I continue to work passionately in this field is that I have witnessed firsthand the benefits of EHRs. Popular Science Magazine found that medication-related deaths account for more than 25 deaths per 100,000 people in 2010, surpassing diseases like HIV/AIDS in mortality (at 19.1 deaths per 100,000.)
The majority of the medication-related deaths came as a result of prescription medications. The clinical decision support alone, available in a properly chosen EHR, is reason enough for my continued passion towards the advancement of technology in healthcare. That being said, we are in the midst of a period of reflection. Much labor and expense has been committed and implemented into technologies, and it is a difficult decision to cut losses and move towards technological improvement. However, considering the end game of promoting revenue, continuing to capture stimulus dollars, and improving patient care, it behooves providers to evaluate their current technological “solutions.” In my opinion, one should not be hamstrung by the fallacy of ‘sunk costs’ in determining whether or not to change vendors, but rather should carefully analyze their current status quo to determine whether or not it can be improved.
With the Accountable Care Act at hand, Meaningful Use underway, and the transition to ICD-10 looming, physician practice owners will need all the help they can get to maintain, let alone not to lose, revenue. They deserve the proper tool to do so. Why try to use a hammer to complete a job when you really need a wrench?