A properly designed EHR/EMR using Product Development and Design for Six Sigma (DFSS) process could be far more cheaper, easier to implement, and physicians might proactively seek it out.
Electronic Health or Medical Records have been in discussion for a while. The adoption rate for EMRs, however, have been somewhat lukewarm. Many believe that it is cost prohibitive for smaller clinics, and many other believe that the old school doctors are just not open for new technology and so on. Needless to say that its adaptation has slowly grown over the years. ( Ref: EMR Survey Utilization Released ) http://www.hospitalbuyer.com/industry-market/partnerships-consortia/emr-survey-utilization-released-1731/
However, the new government in US has betted that the utilization of EMR will not only reduce cost of healthcare but would also improve the quality of care. Government is planning to spend about $20 billions for the implementation of EMRs.
This raises very important questions.
1) EMRs have been around for a while, why do we need to invest so much more money on it?
2) What is the real reason behind lack of drive about EMR adoption?
3) Why is it considered cost prohibitive by many and too complex by many others?
4) Would it really save money that can justify the use of over $20 billions?
So, what can be done to create an effective EMR?
What we have missed out in the discussion about the EMR is about the quality of the product itself. Yes, we can blame the old dogs not willing to learn the new tricks, the cost being too much and so on. What people have forgotten on the development of EMR system is the voice of customer. Or other possibility – and in my experience more likely – is that the team needed stronger product development experience. The question these developers and sellers should have been asking should have been more on aligned with what is really needed, what would make its use easier and convenient. People have tried to sell the technology rather than the product….the ease of use and implementation.
It begs the question whether we are trying push this technology and tool or we are going to create so much value in the product that the adoption is by word of mouth.
Given the result today of its use, It seems like we have missed out the significant links in the product development process.
We are trying to sell the technology while what sells is value.
What is value? It is a long topic. It lies in the eyes of the stakeholders, users, customers. etc. A quick thought about these could lead one to think of the following while developing an EMR which is easier to implement, safe, user friendly, and cheap.
1) Ownership of record management should be shared between patient and physicians.
2) The records needs two types of security: storage and transmittal.
3) Portability among systems and ability to interface with various systems.
4) It should be broken into different blocks. Such as demographic information, chronic disease or wellness management information, emergency management information, and images etc.
5) Each of these should be transferable independently without any problem of data integrity.
6) It should be smart for the physician to find the relevant pages without too much search.
7) For clinical research and public policy purposes, the data should be dumped in a central location without any reference to the person. Thus obviating the security need there.
It should have configurable user interface such that only most used fields can be grouped for regular updates customized to individual needs.
9) Patient as well as physician should be able to look at chart of past performance with a click of button
10) Key milestones should be graphed chronologically for easy study of the patients history. For example, there should be a chart which maps the sugar level, other blood pressure, other cholesterol level, etc. May be there should be chart simply graphing the immunization.
11) Continuation of data integrity may require the records not to be made permanent till reviewed by Primary Care Physician.
13) It must have change management integral to it.
12) Provide flexibility of selective data sharing
13) The entry and view of the information should be made platform independent or at the least platform adaptable
14) Physicians are used to flipping through the pages which does save more time that scrolling documents. The report should be organized in such a way that classical users do not see the difference between using a hard copy versus computer copy. Make it more like a book reading.
15) and many more……….
A macro view would indicate that a world class EMR can be developed and implemented in – most likely – less than one billion dollars. May be in a lot less than that. If we follow smart product development process and create smart policies in support of it. We can do it if we take all the stakeholders needs in the development process as guide.
I am confident a world class system can be designed and implemented in relatively short time. If we do this smartly, we might also have some money left for insuring the poors.
Author:Dr. R.K. “ravi” Pandey, BIPRO Inc.
http:// www.biproinc.com/healthcare_services.html
4 users commented in " Designing the Specifications for Electronic Health Records (EHR) "
Follow-up comment rss or Leave a TrackbackI wish this is the type of approach people had taken earlier. Now we already have a system that might take too much money patch.
Start from scratch! What a novel idea to save money. I do understand that it will have impact on cost and quality. What I do not get is the emphasis being put on the extent of benefit. It is not there no matter how one looks at it.
There’s definitely an opportunity for a disruptive force to enter the market.
JanM, starting from scratch might be the best option for many vendors. Some of their systems might be designed well enough to enable improvements in the user experience and feature extension without major server-side re-factoring. Other firms with aging applications can consider becoming their own competition by developing their next-generation product from the ground up.
I’ve seen issues like these in other niche products. Often they are developed by talented, tech-savvy subject-area practitioners. As first-generation offerings they are often better than nothing and tend to get the core functionality right. After all, the most efficient development process is to roll the SME, BA, designer, engineer, and developer into the same person! That’s frequently not the best recipe, though, for creating widely-adoptable products, despite the talents of the original developer. There’s little incentive, though, for those niche-serving companies to further develop their products. First, they can’t sustain the effort indefinitely. Second, once they’ve met their own immediate need, or have a reasonable income stream from their 1st-generation product, there’s little incentive to undertake the development cost of the next generation. Third, some niche products are not easily refactored to achieve the kind of improvements necessary for wide adoption.
There’s a big competitive advantage to be gained. I wonder if the time is right. Under the vastly greater demand expected under the stimulus plan, the economics in the space aren’t about getting a bigger share of the pie. Everyone is getting a piece of a growing pie. Someone might emerge to dominate the market, but as we know from other software products it’s not necessarily true that the best offering will win.
There is no perfect time except now. If we are willing to put billions of dollars now, then now is the perfect time. If you look at the products coming out places like Cerner, McKesson….It is shameful.
They are good at selling but not at delivery. It is more of a false promise.
Dr Pandey,
What you have put is a very good way to look at the EMRs/EHRs. I wonder if you would be open to the idea of providing your input on the product development process and strategy.
Thank you for the article.
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