Paul Roemer, Managing Partner, Healthcare IT Strategy
Is there a best EHR system? Perhaps Cerner, Epic, GE, or McKesson? For those who have followed my writing, you’re probably thinking my answer is “None of the above.” I’ll do one better, and I write this with the utmost sincerity—it does not really matter which vendor you select. As the EHR vendors reading this pull themselves off the floor, permit me to explain why.
Researching the question, I’ve found very little information to support the notion that any of the major hospital EHR systems quantitatively stand out from the others.
There are a few sites that offer user assessments across a range of functions, but those have at most three opinions—not enough to consider statically significant. There are plenty of EHR scorecards and comparison tools, just not many scores. The vendors’ sites do a poor job of differentiating themselves from their competitors. Vendors use superlatives and qualifiers in an attempt to differentiate themselves, but no vendor highlights major clinical or business problems that their solution solves which another vendor does not.
The only information I found that might be worth a read comes from KLAS Research, http://www.klasresearch.com/. However, the names of the modules rated are vendor specific, and none of the vendors use the same names. It will give you a feel for how a feature rates within a given vendor, but there is no data to suggest how those ratings compare among vendors.
If this is a fair assessment, what accounts for the difference? How can we account for why one hospital loves a given EHR system and another one hates the same system? Chances are they both needed about the same solution. Chances are they received about the same solution.
Here’s the difference. The hospital who thinks they made a good choice:
- Had a detailed strategy and implementation plan
- Paid as much or more attention to process alignment, change management, and training as they did to the implementation
- Managed the vendor instead of being managed by the vendor.
Simply put—the problem is not the EHR system.
One other thought. Do not put your scarce capital into a solution just because it offers or promises either Certification or Meaningful Use. Yes, there is much discussion about both of these. The industry stops and holds its collective breath each time a new set of stone tablets are brought forth from the ONC or CMS. You can meet Meaningful Use with a Certified system and still wind up with a system the users hate and that does not support your business model.
Here is something else I cannot explain. For those hospitals replacing $100 million EHR with another $100 million EHR, why do they think the second system will be any better? If the systems are not materially different, the only way to get a different result is by changing behavior, not changing systems. Why make the same mistake twice? What could be so wrong with the first implementation that an expenditure of far less than another $100 million could not solve?
What is the cost of EHR 2.0 not working? I’ll let you know as soon as I see an organization going for the trifecta.
marcdparadis says
Paul – excellent post, I could not agree more! In all of my years in data management, data warehousing, business intelligence, reporting and analytics, the one incontrovertible truth has been the maxim I learned as a fresh-faced consultant “Perception IS Reality”.
Perception is not dictated by feature sets, timelines or even ROI. Perception is dictated by change management, expectation management and relationship management.
I know that I sound a bit cynical here, and I do admit to overstating my point, but especially in a situation where the available technical solutions and talent are roughly equal, the differentiator is not the technology. In these situations, the differentiator is sponsor and end-user satisfaction. Guaranteeing their satisfaction is first and foremost a soft skill. Admittedly, the hard skills of preparation, execution and delivery will tend to produce satisfied sponsors and end-users, and so should not be ignored. But to proceed with a project solely on the basis of these hard skills is to risk snatching failure from the jaws of success.
Paul Roemer says
Einstein defined insanity as doing the same thing and expecting different results. It will always be easier to simply buy an EHR and trust the vendor to get it right than to take responsibility for the outcome.
Gerry Higgins says
Paul-
Great insight, as always. However, I have to disagree on at least one point.
The usability, including user interface, of the whole range of EHRs are uniformly terrible. They violate many of the principles of the NCI’s own http://www.usability.gov, as well as those delineated by Ben Sheiderman in his great text (“Designing the User Interface”), and those suggested by the somewhat dated document from HIMMS on usability for EHRs: http://www.himss.org/content/files/HIMSS_DefiningandTestingEMRUsability.pdf.
In DoD, the strict principles of user-centered design, cognitive task analysis, etc., are followed, but certainly not by developers in the EHR domain.
Paul Roemer says
Thank you Gerry.
You make a strong point and one I overlooked. I think we’d agree the vendor’s approach is by design and part of their business model. These are the same firms who don’t rally support for defining standards nor do they open their interfaces to the HIEs.
This is probably also part of their strategy–maximize their installed base; acquire competitors and flip their client base to their own. Perhaps when two or three firms own 60-70% of the large systems market they will have created a de facto standard by default.
dgash says
Excellent post. In my experience those that have successful impelmentations of technology have a leader who champions the effort, a team that focuses on improving process, and have defined success metrics. It is amazing what a highly motivated group can do that others can not with the same solutions.