About Healthcare Insighter



What: Perspectives shared with patients, policymakers and those working in the eHealth domain

Why: To promote disruptive transformation toward high-quality, sustainable healthcare

How: Blog posts that uncover, explain and critically assess issues that others misperceive, misunderstand, misrepresent or just plain miss




Why EMR flaws persist

Those of us in eHealth have grown accustomed to the endless articles and surveys about physicians’ and other users’ dissatisfaction with current EMR flaws. Users have developed an explanatory narrative for these reports: EMR vendors are neglectful of their customers, showing little interest in correcting the problems. Furthermore, the fact that it’s so difficult to migrate from one EMR product to another makes users prisoners of their current software. That means that vendors are serial abusers of the power they hold over their customers.

But what if that narrative is wrong? More specifically, what if the vendors aren’t taking advantage of their captive users but instead are simply not very good at what they do?

That thought first occurred to me last year, when I attended an event put on by our EMR provider. And it was confirmed again during an exchange with them this month.

Going back to last year, the vendor claimed that they were working diligently to address customer dissatisfaction. And they told their audience that the steady drop in the number of incoming support calls, something they nicely illustrated in a graph, was evidence that they were succeeding.

However, I had an alternate explanation for the reduced volume of calls: the poor performance of their support infrastructure. As many of the assembled customers knew, the drop in call volume coincided with a spike in telephone wait times. What our provider saw as proof that customers were happier, I saw as a refusal by physicians and other users to spend excessive time reporting observed EMR flaws.

So, I stood up and said so. But I didn’t stop there. I also asked everyone present if they knew of one or more problems with the software that they had failed to report. Every hand in the room went up. I then asked how many had three or more problems and about a third of the customers raised their hands.

The shocked look on the faces of the company representatives revealed that they had no idea that they weren’t getting a good picture of customer satisfaction. For their part, my fellow customers looked sheepish; I assume they felt guilty about not doing their part to improve the product.

As the exchange and meeting ended, our unnerved vendor representatives urged us to please take the time to report all EMR flaws to them, promising to be responsive.

Skeptical, my practice nevertheless resumed our reporting of every problem we identified, using email because it takes much less time than phoning. But we soon discovered that a significant portion of our submissions didn’t receive acknowledgement, let alone lead to a fix. As a result, we re-learned our former “learned helplessness” and stopped emailing. If something big arises, we set aside time to call the support line.

Which is what I did this month when I found a bug that I felt posed a danger to patient safety.

Things started out well: I quickly got through to a helpful and reasonably knowledgeable support person. However, the call dragged on for 15 minutes after I demonstrated the problem (via remote access) while the person
• Searched the support database for reports of similar problems
• Recorded multiple screenshots
• Queried the server logs
• Uploaded data for further analysis
At no point did it seem that I could have ended my participation, so I sat at my screen through it all.

Obviously, no amount of cajoling is going to get users to reliably report EMR flaws if each occurrence costs 30 minutes of the user’s time. Which begs the question of why the intake process for bug reports is so time-consuming? Is it deficient systems? Poorly-designed workflows? Insufficient training?

The likely answer is “yes”, which explains the persistence of EMR flaws at two levels. First, the process for recording and fixing them is inadequate. And second, the EMR product itself suffers from the same design, execution and implementation failings as the support infrastructure.

Perhaps all this is the consequence of EMR vendors being lazy and selfish. But if companies build ill-conceived and badly-coded software, don’t understand their customers’ experience with their product and can’t find efficient ways to correct problems, that doesn’t mean that they’re nasty, it means they’re not very smart.

And that opens the door for clever people to create next-generation products and services that let healthcare providers get on with their work instead of facing the continuing intrusion of EMR flaws.




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