This article has some great observations and sound bites, including the mention of a hospital promoting the lack of an EMR in their employee recruiting ad as a reason to work there.

Health IT is often touted by IT professionals (myself included) as necessary for the digitization, consolidation, aggregation, integration, access, and exchange of a patient’s information.

The article describes how the introduction of an anti-social third party—a computer with an EMR on it—affects the physician-patient relationship.

It also talks about the current state-of-the-art for user experience design within EMR systems.

In an example of a near fatal medical error involving an EMR, it mentions a phenomena often known as “alert fatigue”, whereby a system provides so many alerts, they become ignored (or disabled). IT professionals may have experienced this in poorly configured system monitoring solutions.

See this article for an more in depth explanation of the problem that caused the medical error.

In talking with organizations that are in the throws of EMR adoption, they are focused on data migration, interface development, pre-canned training, roll outs, organization redesign, and cost management. There is little time for reflection on user satisfaction or efficiency. Vendors trying to sell their solutions into one of these organizations often find it difficult, as resources are scarce and the motivation to add yet another system to manage/interface is low. Budget holders are reluctant to spend money on solutions if their pending EMR promises to have similar capabilities (even if this claim is yet unproven).

When I encounter an organization that is well past their EMR implementation, they are typically looking for ways to optimize their use of the EMR. This may involve configuration changes to the EMR or changes to their workflow, but often involves the use of add-on solutions to fill gaps, or “hacks” to provide alternatives to the user interfaces provided by the EMR to their users.

The above observation on how organizations differ based on where they are in their EMR adoption, makes me think about this excerpt from the article…

“In the 1990s, Erik Brynjolfsson, a management professor at M.I.T., described “the productivity paradox” of information technology, the lag between the adoption of technology and the realization of productivity gains. Unleashing the power of computerization depends on two keys, like a safe-deposit box: the technology itself, but also changes in the work force and culture.”

I think that where Brynjolfsson is recommending  that both “keys” are considered and used in parallel—at least where EMRs are concerned—we are more often than not using them serially. First, get the EMR in as quickly as possible (to save costs and hopefully to reap the rewards promised sooner), and only after we better understand what we actually bought and have, start to figure out how to do it right.

There may be no better way, given that healthcare institutions can’t just stop and “reboot” themselves with a system and staff that is optimized. But, one can imagine that living and working in that period following an EMR implementation, and before the age of enlightened optimization, can be painful and frustrating (and even dangerous, as the article shows).

So, maybe promoting the lack of an EMR may attract those people tired or afraid of the post-EMR, pre-optimization period, as there they can be happy. For a while.