President Obama signed into law the Health Information Technology for Economic and Clinical Health Act, as part of the American Reinvestment and Recovery Act. According to Forbes, “the law provides some $20 billion to get medical care providers to use electronic medical records.” $20 billion dollars is quite a chunk of change, which should give you an idea of the transition barriers. Flash forward to today, providers are still stuck in different stages of adoption. Some have fully implemented electronic forms, some are midway there and some are barely beginning. According to the law, starting this year, hospitals and doctors will be subject to financial penalties under Medicare if they are not using electronic healthcare records.
Not On the Same Page
Unfortunately, there is a bigger problem: we approached this the wrong way from the beginning. The law came quicker than the technology. By that, I mean that this law didn't seem to fully grasp how the requirements would affect the stakeholders. As a result, the technology was adapted in a rush without seemingly aligning with the user base. InformationWeek wrote an excellent article about how difficult it is for medical professionals to cut the paper cord completely. Most healthcare facilities are at such different stages with electronic forms that it has been a real challenge to exchange information smoothly.
Sunk Costs Give Sour Taste
In an article entitled "A Major Glitch For Digitized Health-Care Records", the writer talks about the astronomical cost of these technology products, "a full suite of technology products can cost $150 million to $200 million. Implementation- linking and integrating systems, training, data entry and the like-can raise the total bill to $1 billion." These large investments are quickly turning sour, as providers are realizing the promised cost and quality benefits aren't palpable. These sunk costs can be mainly attributed to the software, which is described as "generally clunky, frustrating, user-unfriendly and inefficient."
The Power of Paper
Paper does still hold a psychological power. Scientific American recently published an article entitled, “The Reading Brain in the Digital Age: The Science of Paper versus Screens”. According to the article, "surveys indicate that screens and e-readers interfere with two important aspects of navigating texts: serendipity and a sense of control. People report that they enjoy flipping to a previous section of paper when a sentence surfaces a memory of something they read earlier, for example, or quickly scanning ahead on a whim. People also like to have as much control over a text as possible—to highlight with ink, easily write notes to themselves in the margins as well as deform the paper however they choose.”
How does this relate? Well, in the healthcare industry where every detail matters among a surfeit of data, paper holds a sense of control that maybe shouldn’t be replaced by digital forms. Granted, redundant documentation exists that is not vital and should be digitized.
It Takes Two
It is a well repeated argument that technology needs to understand its user base to be successful. This happened to be their fundamental missed step. Implementing research studies, looking at case studies and observation are all lost opportunities here. We go into more detail about how you should do this in a previous blog post entitled, "Improving the User Experience in Mobile Forms".
Peter Pronovost MD, VP of Patient Safety and Quality at Johns Hopkins accompanied this point, “Medicine today invests heavily in information technology, yet the promised improvement in patient safety and productivity frankly have not been realized.” He continues, “But the potential is not going to be realized unless those tools are really focused on improving patient safety,” he said, “ The tools themselves won’t automatically do it.”