Brian Klepper
Over the weekend we had a small dinner party, in which one of the guest couples’ daughter, a delightful 2nd year internal medicine resident at a major academic safety net health system, tagged along. Over the course of the evening, she told me many things that reflected the intense frustration that any young physician would have with the current system. The quotes below are paraphrased, but I’ve tried to ensure that sentiments expressed are accurate.
“My hospital uses EPIC, which is a terrible system. It’s unintuitive, and so many simple things that should be easy to find – a particular lab test or a diagnostic image with a certain perspective – are often buried and not easily found, even with the search function. I can spend 10 minutes looking for something that should be easy to navigate to but isn’t, which continually slows down my productivity. All the residents are frustrated with the way it wastes time by simply being at odds with the ways physicians think and work.”
“Learning a new, complicated electronic medical record (EMR) is like learning a new language. It takes time, but when I’m finished here and move to the next hospital, I’ll probably have to learn a different system, which will be an additional waste of time. The lack of standardization may serve the vendors’ interests, but its costly to health care organizations, clinicians and patients.”
“When I’ve called on the EPIC support staff, they’ve responded by asking whether I know things like my log-in and whether I’m computer literate. I’m 27 and, like nearly all my peers, I have used computers my entire life. I’m comfortable not only with Apple and Windows but with Linux. My sense is that the support people and maybe our own administration think that the difficulty is with the clinicians but, at this point, we know the difference between an ergonomic and a lousy application. The residents I work with believe that this is just a bad app, and that we’re stuck with it. Tools built like this slow us down rather than facilitate better care. I have to believe there are better designed EMRs out there.”
“In a 12 hour shift, I can only spend about 4-5 hours actually caring for patients. Most of the time is spent charting or trying to navigate insurance. I never imagined that this is how doctors would spend their time.”
“I’m assigned to the indigent care clinic, where I see many patients with serious problems but no money. We often don’t have specialists or diagnostics to refer to if there’s no insurance, so our options for caring for these patients are very limited. The patients are usually very aware that there are possible next steps, but there’s often nothing the physicians can do without coverage. It’s a shameful situation.”
Care And Cost 
And just who’s bright idea was it to twist arms to bring electronic records system to our hospitals??
After working in a few dozen hospitals implementing systems and having seen how decisions get made (e.g., a nationally respected hospital that was in year seven of debating what the unique patient identifier in the system we were going to implement), I’ve come to a rather simple conclusion. Brutally long, convoluted and mass consensus driven decisions pretty much guarantee that the only vendors who can survive through that are the legacy vendors with large install bases, war chests, etc. The reward at the end is an epic price tag and technology that has woeful usability.
There have been many vendors who could have competed with the brutally unusable and expensive had the decision processes not been interminable. Until health systems fix their decision processes, they’ll get exactly what they’ve been getting. If they had reasonable decision processes, they’d see what virtually all other sectors have seen — i.e., the consumerization of the enterprise where software is orders of magnitude less expensive AND it’s dramatically easier to use.
Now that I have a startup of my own, I’m not even approaching the large health systems as we’d die on the vine waiting for the vast majority of them. We’ll only work with the ones who approach us even though (in our admittedly biased opinion), we have breakthrough software that would be applicable to the large health systems as well.
The good news for your friend’s daughter is the playing field is leveling where small healthcare providers will leapfrog large health systems with systems that are highly affordable/usable. They no longer have to be held hostage by expensive and unusable systems.
It’s also why healthcare is approaching 18% of GDP. Kaiser (an Epic installation) estimates that the total project costs (including training and lost productivity) will be $4B – over 10yrs. For more insight into Epic (a private company that started in 1979 with $70k) – these two articles are eye-opening – as well as eye-popping:
Wired Medicine’s Silent Giant (Forbes – 10/08/09): http://bitly.com/1nvrkf
Epic Systems’ $300 million expansion tangible sign of success (Journal Sentinel / Milwaukee Wincosin – Aug 2008): http://bit.ly/vMVJYL
My biggest beef isn’t with the “startup-to-giant” story-line – but rather the lack of interoperability (legendary) – and the antiquated nature of the core technology – MUMPS. For those a little less well versed in MUMPS – Lee Faus over at Axial Project wrote a great blog in March on the need to re-architect VistA (also MUMPS) which is used by the VA.
Architecting VistA for 2011 – Lee Faus – March 2011: http://bit.ly/h5wZvd