Tuesday, March 14, 2006
Electronic Health Records... around the corner or over the cliff?
In my Document Engineering and Information Architecture course at UC Berkeley we recently discussed an August 2005 case study article from the Annals of Internal Medicine called “Electronic Health Records: Just around the corner? Or over the cliff?” Unlike many case studies that strive to present the facts in the best light, this one tells the story of a small medical office’s efforts to adopt electronic health records and other electronic documents with unexpected honesty… maybe naïve honesty. I highly recommend it to anyone considering a document automation effort, especially in healthcare.
Reducing costs and improving efficiencies by automating repetitive document processing within its office and within its “ecosystem” of labs, clinics, pharmacies, and 3rd party payers were the primary motivations for adopting a system. Unfortunately, the staff and physicians had grossly unrealistic expectations about how easily they could learn to use the system and didn’t count on having to radically redesign “15 years of accumulated workflow” to make it work. Furthermore, much of the pain and productivity loss was self-inflicted. Without evaluating any alternatives, they chose a system that imposes a rigid repertoire of 24 document types that that won’t let any document be filed unless it has been assigned to one of those types. And instead of preparing electronic records for their existing patients ahead of time, the staff waited until patients came for appointments to begin any legacy conversion.
Somehow these folks got it all to work, and they say that they are now better physicians and wouldn’t go back to the paper document processes. But I suspect that the lessons they report in this article will be learned the hard way by many other physicians – maybe because doctors have to be smart, they can’t believe that document automation can be that challenging.