"Improving Health by Clicks” instead of “Death by a thousand Clicks"
by Jan Poort
Electronic Health Records (EHRs) were described as a way to make medicine better, faster, cheaper, and safer. However, an April 2019 article in Fortune, “Death by A Thousand Clicks”by Fred Schulte and Erika Fry have raised serious questions. Ten years and $36 billion later, the system is an unholy mess. Although the article does mention some positive outcomes of EHRs, the focus is to warn of the harmful results.
First, physician satisfaction is important, because physicians will be the system users.it seems that in order to design an EHR system that could be utilized by all physician and for all possible situations, the program designers created elaborate systems that required several steps and clicks of the computer to find relatively simple concepts which made relatively simple things frustrating and impossible.
EHRs could be a way of institutionalizing the best approach to various diseases taken by the best physicians in the world. Taken to another extreme, computers could learn how to diagnose diseases without the need, in theory, of a physician. This is already happening; and anyone with a little experience can diagnose themselves with google or YouTube. Soon, Apps will be built, where people will be able to diagnose themselves more reliably than doctors. The value of a physician is intelligence, and what is more intelligent than a computer. Currently, the physician’s experience is better and more reliable than a machine, but this is changing quickly. This doesn’t mean that we will completely eliminate the need for doctors, but it does mean that medicine will integrate technology that augments the way medicine is practiced.
Second, Physicians have to cognitively switch between focusing on the record and focusing on the patient. The physician is requested to move from writing in pen to [entering a computer] record, and it’s pretty complicated interface.
Third, the patient is concerned with two main issues: privacy and outcome. Are the EHRs secure and will they lead to better outcomes at a reduced price? The privacy issue is compromised by the different motivations of the manufactures, hospitals, and patients. The information in the medical file is personal to the patient and any breach of the file is potentially harmful. If the file is compromised it is only inconvenient or embarrassing to the software manufacturer or hospital; but it is tragic to the patient.
The U.S. government push for EHRs.
· EHRs is what the government mandated,
· Vendors had to develop systems that met the government’s requirements. What are these government requirements and were physicians involved to develop the functional specifications?
· The need to stimulate the economy (the industry’s race to market took priority over all else).
Large public multimillion funded software projects fail consistently for two reasons:
1. The project is too ambitious,
2. The project is too complex.
Lessons learned; develop a realistic plan in terms of budget, time and target and don’t pay in full a software developer before the product meets the functional requirements.
Jan Poort is a seasoned high-level global IT executive. Jan has well-rounded skills in general management, software development, IT operations, sales and marketing. He has worked in Europe for such powerhouses as Unisys, HP, Digital Equipment, Minihouse and Philips Data Systems.