The other day, when I was researching my post about Thomas Friedman and Obamacare, I contacted an old blogging buddy of mine – I was on the Watcher’s Council with him a few years ago – Scott Kirwin (aka The Razor).
Scott views Obamacare through the prism of his wife’s medical practice and his own experience in data processing.
While Scott hadn’t written the post I thought he had, our exchanges led to his own critique of the Friedman column, Electronic Health Records: The $6 Billion Cure For Bad Penmanship.
Being married to a doctor and an IT professional specializing in “big data” in the financial industry, I have watched the Wife’s experience with various EHRs with levels of amazement and dismay. It’s as if the lessons learned by the financial industry in the 1990s, such as poorly designed software that is incompatible with other software will cost more money to replace than it did to implement in the first place, have been completely lost by the lemming-like rush towards electronic health record (EHR, also known as electronic medical records EMR) systems.
The basic problem is that EHRs are not designed to suit the ways doctors practice. This is complicated by the fact that the way doctors practice varies between specialty, an orthopedic surgeon doesn’t practice medicine the way a primary care physician does, and by the additional complication that how doctors practice varies within the same specialty, often the same office. Even the same doctor will treat patients differently depending on what he feels works best for each patient. Yet these variances between specialties are only rudimentarily addressed within EHRs, and handle variance within specialties one of two ways, providing either a set workflow that dictates to the doctor the way she should practice, or one that provides so much flexibility that she is lost trying to get basic tasks.
The key decision in any software development is to address who the software is for and the key needs it is meant to address. Judging by the current EHR systems available none were designed for doctors. Instead they were designed for the employers of doctors such as large health systems, insurance companies and the federal government who are interested in aggregated data in order to answer questions such as “How many patients are uncontrolled diabetics?” or “How much is being spent on obesity-related illness?” These are questions which might be of interest to a doctor in general, but they are not what he’s thinking about when he’s facing his patient, say a morbidly obese, uncontrolled diabetic medicaid patient. Instead he is interested only in that particular patient’s problems. Is her agoraphobia contributing to her obesity, or is it the result of it? How can he wean her off HFCS soda and begin to move and diet when getting her into his office requires so much effort? Most of all, how can he encourage her to take an active role in her own medical care and help him treat her?
While I rejected Friedman’s premise that Obamacare spurred innovation, I accepted his premise that the innovations he wrote about would help improve healthcare. Scott’s well-documented response instructs otherwise. The innovations heralded by HHS and celebrated by Friedman are geared towards the government and insurers rather than doctors and patients. This is also a sense I got from a number of commenters.