Back to EHR Basics, Part 1: The Fewer Choices, The Better

You may have been taught that the customer is always right, but it’s been well-established that the customer is most certainly not always right (see my posts here and here). Plenty of successful, innovative business owners point out the fact that often, the customer has no clue:

• Henry Ford: “If I had asked people what they wanted, they would have said faster horses.”
• Steve Jobs: “Some people say, ‘Give the customers what they want.’ But that’s not my approach. Our job is to figure out what they’re going to want before they do.”

Innovative products and services often arise from the entrepreneur who can intuitively see the pain points that his or her customers have and solve them in new ways that no one had previously contemplated.

Let me continue this argument by noting that sometimes, product success lies not in the options you present to your customer, but in the lack of options. Remember Henry Ford? He wryly said that his “customer can have a car painted any color he wants — as long as it’s black.” Steve Jobs built a ground-breaking mobile operating system that will run on any cellular phone you have — as long as it’s an iPhone. And once you have that iPhone, you can run any applications on it that you want — as long as the apps have been tested and approved by Apple and made available exclusively through Apple’s App Store.

So, the customer is not always right, and sometimes, limited choice is a good thing. How is this related to the electronic health record (EHR)?

When EHRs were a new concept (who remembers life before Meaningful Use?), software vendors often promoted their products by emphasizing all the configuration options that were available. Can’t you just hear the sales slogans?

• “No need to change your workflows. We can modify the program to work the way you work.”
• “This hospital is the best hospital because you do things your way. We don’t want to get in the way of that.”
• “You’re a top 10 hospital. We want to learn from you. What do we know? We’re just a software company.”

Oh, how things have changed.

Nowadays, the top EHR vendors are very prescriptive — and that’s a good thing. The message goes something like this: we work with hospitals and health systems just like you all over the world. Our customers have helped us figure out what works and what doesn’t work. You may be different (and – wink, wink – better) than your peers, but you’re not that different. You should probably try to stick to our recommendations whenever you can.

I’ve worked with health systems who are pulling out perfectly good EHR builds to swap it with standard vendor recommendations. Why would they do such a thing? Because they know that the more closely they align with the vendor’s suggested configuration for common workflows, the better off they’ll be for the future. How can vendor alignment help?

• It’s much easier and faster to adopt new development if you don’t need to modify customized changes that you made years ago.
• Vendor-created reports and training tools can work out-of-the-box if you’ve followed the vendor’s recommendations.
• Benchmarking with your sister institutions just plain works if you document and order in a standardized way.

While I may have convinced you that more standard, vendor-recommended EHR build is a good thing, some IT analysts aren’t feeling all warm and fuzzy. Can you blame them? In the good old days, they met with the end users, listened to what they said they wanted, and built it. It was fine. It worked. Everyone was happy. Maybe. Yet now, some analysts feel that by following the vendor, they must ignore the end user. I was told of an analyst who said to her supervisor, “I hear you. I understand. I shouldn’t talk to the users anymore because they don’t matter.” That response isn’t going to go over well, but I get it; I see where she’s coming from.

Craig Joseph, MD, is the Chief Medical Officer for Avaap, an EHR and ERP consulting firm. He is a pediatrician and physician informaticist with experience in both clinical practice and the use of the EHR to improve patient care and physician efficiency. Dr. Joseph also currently serves as the Interim CMIO at El Camino Hospital in Mountain View, California. This piece was originally posted on Avaap’s blog page.