Tag Archives: EHR

Health IT Adoption Challenges

One of my favourite sources of information on the health IT market is HISTalk, particularly their daily round-up of health IT news.  In this morning’s summary, the editors cited Dr. Robert Pearl, CEO of the Permanente Medical Group,  and his reasons why health IT is not “widely embraced”:

  1. Developers focus on doing something with a technology they like rather than trying to solve user problems, such as jumping on the wearables bandwagon despite a lack of evidence that they affect outcomes.
  2. Doctors, hospitals, insurance companies, and patients all feel that someone else should pay for technology they use.
  3. Poorly designed or implemented technology gets in the way of the physician-patient encounter.
  4. EHRs provide clinical value, but slow physicians down.
  5. Doctors don’t understand the healthcare consumerism movement and see technology as impersonal rather than empowering.

The editors also offered their own thoughts on this topic, citing the following impediments to health IT adoption:

  1. People embrace technology that helps them do what they want to do. Most healthcare technology helps users do things they hate doing, like recording pointless documentation and providing information that someone else thinks is important.
  2. Technologists assume every activity can be improved by the use of technology. Medicine is part science, part art, and technology doesn’t always have a positive influence on the “art” part.
  3. Healthcare IT people are not good at user interface design and vendors don’t challenge each other to make the user experience better. Insensitive vendors can be as patronizing to their physician users as insensitive physicians can be to their patients.
  4. Technology decisions are often made by non-clinicians who are more interested in system architecture (reliability, supportability, affordability, robustness, interoperability) than the user experience, especially when those users don’t really have a choice anyway.
  5. Hospital technology is built to enforce rules and impose authority rather than to allow exploration and individual choice. Every IT implementation is chartered with the intention of increasing corporate control and enforcing rules created by non-clinicians. That’s not exactly a formula for delighting users.

What are your thoughts?  Do any of these reasons ring true for you?  Would you challenge any of them as incorrect?  Do you have any reasons of your own to add?



Tugging on Superman’s Cape – Contrarian Views Applied to the Digital Health Agenda

I have teamed with my friend and mentor, William Pascal,  to write a series of articles challenging conventional wisdoms about the Canadian digital health agenda.  Here is the first article in the series which sets the stage for the remainder of the articles

“Time spent arguing is, oddly enough, almost never wasted.” ―Christopher Hitchens, Letters to a Young Contrarian


What if we do not need new funding for the digital agenda in Canada? What if we no longer need a Canada Health Infoway or similar bodies such as eHealth Ontario? What if we are less concerned about privacy and more concerned about delivering better care? What if the private sector manages all back office operations for the health sector? All these statements are contrary to conventional wisdom, but are they wrong?

What is conventional wisdom? It can be defined as ideas so accepted they go unquestioned. Think about the Wright brothers. If they had listened to conventional wisdom, they would never have even tried to build a flying machine and our world would be a very different place. Think about the impact on society today if Alexander Graham Bell had been discouraged and gave up when he was told that his invention of the telephone had no inherent value by Western Union.

Too often we accept what’s conventional thinking without trying to see what’s possible and available. The real problem with using conventional wisdom as a guide is that we will constantly be behind the curve, safe with the general masses but missing the opportunities to think independently and create something new or change an existing way of thinking. Ten years ago, who would have thought we’d be spending more money renting software than purchasing it?. Fifteen years ago, mobile devices were not viewed as a key enabler of care when we created an eHealth strategy for Canada.

New ideas or ways to address difficult issues almost always challenges conventional wisdom. Inspired by this reality, we have embarked on a quest to challenge, through a series of articles, some of the conventional wisdom that we believe underlies the approaches to the public policy thinking that is driving the digital agenda in Canada.

This paper, the first in our series of articles challenging Canadian digital health conventional wisdoms, provides a high level overview of the challenges facing the health care system, a description of the digital agenda in the healthcare sector, the status of this agenda in Canada, some observations on this journey, lessons to be drawn from experiences in Canada and Internationally and a suggested list of contrarian possibilities that draw into question conventional wisdom. Subsequent articles will explore these suggested different future states.

You can read the remainder of this paper here.




Electronic medical record systems: Does one size fit all?

I love fall! Not only for the changing colours and cool, crisp days but also for the many conferences and trade shows that take place this time of year. At the recent HealthAchieve conference, organized by the Ontario Hospital Association, for example, I learned that there is a growing trend in Canadian hospitals towards a single, enterprise-wide electronic medical record system. Experience elsewhere in the world suggests that this preference for single vendor systems over best of breed environments is fraught with challenges and runs counter to the trend in other industries.

Check out the rest of this Technology for Doctors articles here.


EMR Productivity – A Work in Progress

In an October 2010 Healthcare Technology Online editorial, Evan Steele, CEO of SRSsoft, is quoted as saying “Any business that is run on paper is highly inefficient.” He further notes that “decisions based on accurate and complete information … improves the level of patient care while increasing productivity.” Does health IT improve productivity? Recent studies suggest that while health IT tools such as EMR systems do indeed enhance productivity they also highlight that there is still considerable untapped potential for further productivity improvements.

Check out the remainder of my monthly Technology for Doctors column here.



EMR – The Next Generation

Recently posted to Technology for Doctors:

In the previous edition of Technology for Doctors Online, Dr. Brendan Byrne, VP of Physician Solutions at TELUS Health Solutions, described a “new approach to EMR” that he calls “EMR 3.0.” A pioneer in the Canadian EMR market, Dr. Byrne has literally lived the evolution of EMRs in Canada and, as a physician and entrepreneur, he possesses unique perspectives on the EMR market and what might lie ahead. 
I was intrigued by his arguments for a next generation EMR and began musing about what the next generation EMR (also referred as an EHR in the U.S.) might look like.

Please click here to read the remainder of this article



Is there an ROI for Health IT? It depends.

One of the most frequently and hotly debated questions that I encounter in my professional life is whether health IT offers a measurable return on investment (ROI). Various studies and opinion pieces have addressed this question but no clear consensus has emerged. Maybe there is no single answer. Perhaps the answer is: “It depends.”

Check out the rest of the article here


The Applification of the EMR

Perhaps one of the Steve Jobs’ greatest legacies is the iPhone and the app ecosystem that it supports.   Rather than trying to define and develop every bit of functionality that an iPhone has to offer, Apple handed the opportunity to do so to hundreds of other organizations, large and small. Apple gave up some control in exchange for unprecedented growth in market share and, ultimately, stock price.  Imagine for a moment if a similar approach was applied to the design of EMRs and other eHealth applications.  Might the same level of innovation and user adoption result?   A team led by Harvard University seems to think so and was awarded $15M by the U.S. Office of the National Coordinator for Health IT to turn their ideas into reality.

You can read the rest of my monthly Technology for Doctors column here.


mHealth Rant

Check out my latest article in Technology for Doctors, an online publication for which I write a monthly column.  You can find it here.

I’d like to hear views on whether we need yet another buzzword.  I argue that mHealth will cause more confusion among potential users and divide the health IT community at a time when it should be united.





Should doctors be “forced” to use EMRs?

Tom Closson, the Ontario Hospital Association (OHA) President and CEO, created a bit of stir at the eHealth 2011 conference in Toronto when he suggested that doctors should face real consequences for not adopting electronic medical record systems such as not getting paid.   This same sentiment was expressed in a recent article in the Canadian Medical Association Journal.

Tim Wilson, a fellow Canadian eHealth blogger, explored Tom’s comments in a recent blog post.  I commented on this blog post with the following observation:

I agree that mandating EMR use is not the answer, at least not until we get more physicians using EMRs. While it might sound like the easiest path to take, forcing physicians to use an EMR casts them as technology resistors who simply aren’t smart enough to realize the benefits that EMR’s have to offer. Given their education and their use of some quite advanced technologies in other aspects of the practice of medicine, one has to wonder they aren’t pounding down the vendors’ doors to buy an EMR.

I suggested that it was perhaps a bit hypocritical of those who still use pen and paper for many daily work activities to admonish physicians for doing the same.

If we are unprepared to ditch pen and paper, what right do we have to ask physicians to do the same? Clearly there are usability issues still remaining with many EMR products and forcing physicians to use products that don’t fit how they work is not the answer. While I am not naive enough to suggest that usability is the only issue standing in the way of massive EMR adoption, I do believe it is a contributing factor.

What are your thoughts on this matter?  Head over to Tim’s blog and join the debate.


Steven Huesing Virtual Debates – First Debate

About a month ago I wrote a blog post about the The Steven Huesing Debates on Digitizing Canada’s Healthcare System. This virtual debate series is intended provide a platform to engage all stakeholders in open, unfettered discussions about the about the major issues impacting eHealth adoption and use, such as:

  • Measuring the return on value to the patient
  • Improving quality and safety
  • Data sharing to respect the privacy rights of patients
  • The appropriateness of the current agenda

The debates will be conducted virtually and will include a public commenting period. The first debate took place on 12 April 2011 and the public commenting period is now open. You can find information about the debate series as well as a recording and written synopsis of the first debate here.

I urge readers of this blog to participate in the virtual debate. Please check out the virtual debate website and offer your thoughts and comments. In particular, please offer your thoughts on the topics to be discussed In future debate sessions. The currently identified topics include:

  • Patients as co-creators/owners: Should the HIT agenda change to build the infrastructure that ensures personal health information rests with the patient who shares it with others? Do you want patients to genuinely become a co-creators—to share power
  • Aligning business models to incent using these systems: What changes in the current approach (business model and incentives) are necessary to speed up adoption and change processes of care to drive out more value?
  • The need for e-health policy: The technology roll-out is advancing before we have e-health policies in place. What policies are needed to address challenges or potential barriers?
  • Regulation vs. government edict: What would be the best approach to creating a carrot and/or stick regime to speed up adoption by clinicians?
  • The right balance between top-down and bottom-up to drive the agenda: Is HIT in Canada emphasizing a more grassroots agenda driven by the patient and providers rather than a top-down approache driven by governments?
  • Do we need a higher sense of urgency with the HIT agenda? If the answer is yes, then what do we do to build this into decision making and implementation?

What are your thoughts on these proposed topics? Are there additional topics that should be considered? Please go here to participate. Also, please let people in your own networks know about the debate series and encourage them to participate