“If I buy a toaster and my wife says, ‘It’s lousy; throw it out,’ to preserve domestic tranquility I throw out the toaster and buy a new one,” says Ross Koppel, a scholar in the Sociology Department & School of Medicine at the University of Pennsylvania. “If I spend $1.2 billion or $1.7, I am married and I don’t have a heck of a lot of options.”
He says the same is true for electronic medical record (EMR) systems. Over the course of the last 15 plus years, Koppel has studied healthcare IT and pointed out that these systems are severely flawed – at least in part because of the difficulty of breaking free from an ineffective platform.
Everybody knows that EMRs were mandated as part of meaningful use, with an incentive program of approximately $30 billion to encourage the purchase and use of these systems, he explains, but the problem is that when the vendors got a hold of this they essentially had a captive market.
Software was often focused on the billing rather than the clinical elements. “There has been increasing rage on the part of physicians and others about the software not being responsive to their needs,” Koppel notes. “That said, I would be the last person on Earth to argue we should go back to paper. The software is dramatically better than paper.”
Even so, the usability is primitive and the industry has not acted to create common and mutually agreed to interoperability standards, said Koppel. This is the very basis of what it means, he adds, noting that vendors created systems that communicated with themselves rather than across platforms. “As a result, rather than swimming in an ocean of data about our patients, we have isolated Towers of Babel where information is not communicated clearly,” he says.
Koppel does acknowledge some of the incredible challenges faced by these vendor companies he criticizes so vocally. “I recognize that writing the software is very difficult,” he says, “and that it’s complex software with literally millions of moving parts.” He also realizes that in the process of implementation and customization there are all kinds problematic issues to contend with.
“But we have an obligation to expose that which we can address and try to fix it,” he says. “I would argue to the vendors that we can’t make better software by only singing its praises and not looking at its problems.”
The industry itself has recognized some of these problems and is moving toward the creation of data standards, which is essential, Koppel notes. The problem is that those standards should have been established long ago. “Now the existing structures are so embedded that it’s very costly to reach the kind of standards that are needed to allow the interoperability that is the hallmark of a reasonable system,” he says.
Koppel suggests several steps that could be taken almost immediately to help address the issue of interoperability. First, share the bug list and publish it. And give the vendors the opportunity to comment on each item on the list, he says, so if some moron shares a complaint that doesn’t make sense they can address and rebut it, but if they’re downplaying 2,000 similar bug reports with the same nonchalant response it will begin to look suspect.
Doctors should also be given the ability and the right to share screen shots with their colleagues in order to work toward better understanding and addressing the issues they come across. Currently the vendors prevent these screen shots from being publicized, and this is, according to Koppel, catastrophic.
And last, the vendors should refuse to include a nondisclosure and hold harmless clause in the contracts that prevents physicians from sharing discontentment with their software. “These steps could be taken immediately, really,” he says.
Beyond that, Koppel calls for action in terms of the development of standards, suggesting a six week timeframe rather than taking years to continue to work toward that possibility. “We’ve been facing the same bloody problem now for 15 years,” he says. “It’s enough. We just have to deal with it.”