Readers Write

Easily the best part of this job is fielding correspondence from you readers. I've received several observations from recent columns that suggest a tremendous divergence of opinion on exactly why the industry has lagged behind adoption of clinical IT. Tony German, a former hospital administrator from Austin, TX, takes me to task for my column saying that physicians have good reasons for sidestepping EMRs. On the other side of the fence, a physician in Austin praised my article on e-prescribing, which highlighted a few obstacles physicians have faced that account for the almost negligible of a technology with awesome potential. These and other missives follow.

'Problem is the mindset'
I read your EMR article following the visit to the eye doctor.

You're way too kind to the medical profession, health IT pros, and the industry in general. When I see what's going on in IT outside of healthcare, I am impressed at the power of software. Truly impressed. When you see the computing power of a search engine, the online e-mail programs, or even the enterprise applications that are being rolled out, you realize that healthcare is in a different category. Even when you shop retail the IT power is above and beyond what is common in a FP doctor's office, surgery center, or hospital.

The problem in healthcare is the mindset. No one wants to change (why change such a great system, right?); disparate providers hold on to their turf, no one gives in and because the basic economic models don't apply, the patient's needs are overlooked. The investment isn't made (there's plenty of money, by the way) in IT because no one is losing any business or patients because of it.

Tony J. German
Austin, TX

'Atrocious for the physician'
You finally nailed it in the last paragraph. Reality is that the EMR (and e-prescribing) industry is a failed industry. Any industry around for 30 years with its pathetic penetration rate tells you they design and build products not many want and for which the value proposition is not clear. I have been in the industry off and on for 25 years and hence partly responsible but know first hand. If one goes to the dawn of the EMR (or e-prescribing or whatever) you will find an original assumption that physicians will never use it and therefore no investment in physician usability has ever be made. E-prescribing and EMR in general are atrocious for the physician to use. Until someone is ready to address this, short of adoption at gun-point, we will continue at this nonsensical pace. The advantages of e-prescribing should be and are obvious. The devices and methods for making it easy are not. Where it is the i-Phone of e-prescribing? Physicians would stand in line to buy and use it!!

Robert Teague, MD
Austin, Tx

Meeting of the Minds
Another article right on the mark. Your last line, "Consensus has a way of making itself known," rings so true. Ultimately our society works best thru capitalism rather than thru legislation. The first vendor who gets interoperability down WILL get "crush(ed)… with new business" and any thought of legislation will fall to the wayside. The problem is that all too often legislation beats corporations to the market and stifles creative thinking and innovation.

Brian D. Patty, MD, FAAEM
VP/Chief Medical Informatics Officer
HealthEast Care System
St. Paul, MN

'Healthcare is complicated'
I loved your quote (from "Hazing Hillary") below:

"I swear, one reason there has been so little political support for clinical IT is the inability of industry proponents to make a case in anything less than 10,000 words. An open forum always runs the risk of becoming Grandstanding Central."

Although I chuckle and agree with the point, it is undeniably true that healthcare actually is complicated. There are hundreds of different products that automate some portion of the clinical process, and each of these claims some right to be labeled as an EMR. "EMR" as an IT genre is broader than, for example, manufacturing automation. But if we were to openly discuss "manufacturing automation," most folks would say "what kind?" The general ignorance of smart folks in discussion of EMR objectives is underlined by the fact that the "what kind" question is rarely asked.

Tim Breaux
Principal
InterCase

Don't forget HIM
I read with interest your most recent article, "The Eyes Have It." You will find health information management practitioners to be in significant agreement with the need for having sufficient flexibility in the design of documentation templates used by various types of clinicians in different healthcare practice settings. These clinicians in each of these healthcare practice settings—and EHR vendors, themselves—should aggressively seek the services of health information management professionals to build the best documentation tools to support their needs. Our professional educational background and our professional experience with clinical documentation tools makes us the "go to" specialists they can rely on to collaboratively work with them to get that job done well!

Shirley Eichenwald Maki, MBA, RHIA, FAHIMA
Project Director - The ATHENS Project
Healthcare Informatics and Information Management
The College of St. Scholastica
Duluth, MN