Death by a Thousand Clicks Part 4: An Alternate Perspective

This is our fourth part of a four part series looking at the Fortune Magazine article “Death by a Thousand Clicks.”

Part 1

Part 2

Part 3

After reading the article Death by a Thousand Clicks: Where Electronic Health Records Went Wrong, I am taken aback. It's a good read, but it's LONG! That's because there is much to say about something that has required such a national investment. Let me summarize for you: EMR's were supposed to improve the healthcare experience, make healthcare cheaper, and make patients safer…and they've fallen short.

 I worked at Epic for 12 years and am a believer in the ability for EMR's to improve healthcare in this country, which made this article painful to read. Very painful. Being behind the curtain at the "Cadillac of medical software" (per the article) I can tell you this…everyone at Epic was driven to improve patient care. It was our company culture. Our company mantra. Not a decision was made without the thought of how it might impact patient care. Judy Faulkner was our daring and brave leader. A CEO so intently focused on doing the right thing that it was easy to enjoy/ignore her entertaining eccentricity. We were proud of our mission. Hell, I still am!

 So…how and why are EMR's falling short? Frankly, it’s not for lack of trying. But, healthcare organizations are…complicated. If you've seen one clinic's workflows…you've seen one clinic's workflows. This isn't Microsoft Word. I regularly looked around and was mesmerized by the fact that I was working on the most complicated software in the world. And I'm not exaggerating. Orders, visits, specialties, charts, billing, questionnaires, and so much more. All tailored to each organization’s specific workflows and needs…it could make your head spin! And we did our best. I spent hundreds of hours with clinicians in their natural habitat. Watching them work. Watching them interact with electronic systems, paper charts, paper flowsheets, patients, patient families, and more. It was what we did. Anything to learn more about our users so we could craft the system to work for them. I like to hope that every other major EMR vendor out there is operating similarly (although I don't know this).

 Hopping off of my Epic horse now…so why is it not working?

 Can we start with a few things that ARE working? I can pull up my phone and provide you with visit summaries for every doctor visit I've had since I've lived in Madison (16 years!). I can do the same for both of my kids. I can see all of their immunizations with the click of a button. I schedule all of my family's appointments online. I am notified that my kid has strep throat before the doctor gets back to our room! I can refill my meds and my kids’ meds on my phone. I can walk into the doctor’s office, check-in, and be called back to the office within a minute. There are some good things going on and they are hard to ignore.

 What's not working? Well for starters…I live in Madison, WI. A city that has multiple HMOs that all use Epic. The exchange of information is pretty impressive here in Epic's back yard. The incentive to provide this exchange at no charge is pretty high for the local HMOs (you scratch my back, I'll scratch yours).

 But once you get outside of this healthcare utopia…what incentive do providers have to exchange information? The world of healthcare is more competitive than you'd care to know. Would Walmart share a customer list and a customer's purchasing habits with Amazon? No way! So even if EMRs are able to share information with one another…what incentive does one hospital have to make it easy to share information with other hospitals? I know…it's hard to swallow…but patients are customers. Customers with insurance that will pay thousands of dollars for mere hundreds of dollars worth of service. Jackpot! "If the records are hard to transfer maybe they'll stay with us," right?

 Okay…ignore my pessimism and go with the approach that hospitals truly all want to freely share information. If you've worked in healthcare data exchange, you know it reaches a level of complexity that can be almost unfathomable. Many people can dedicate themselves to mapping data across systems for many, many months/years and still come up short. Hospital 1 uses CMP, Hospital 2 uses CompMetPan. And that's just one of thousands of mappings that must occur. This is not easy stuff. But there's FHIR! Most organizations haven't adopted it yet and the technical barriers of mappings and integration are still very real. There's CDA documents! The ability to file this data in such a way that it's trendable and viewable with your organization’s information is very limited.

 It's a complicated landscape. EMRs have done wonders. While reading the above article I wondered how many of those same problems would have existed with old manila-envelope charts? We'll never know…because you can't report on them, but I’d guess the problems and the cost of sticking with paper would be much higher. Your health is FAR better off in the electronic world than stored on multiple shelves unable to be found.

 Speaking of which…we still see a LOT of faxed documents flying around between hospitals and clinics. Until the utopia is achieved, we do a great job of intercepting faxes and scans, classifying them, extracting and mapping the data to your system, and filing it all discretely safely within your system without having to deal with a bunch of extraneous interfaces. From lab results to consult letters, we can file it all right where it should be. We can't solve all of the EMR integration problems for sure, but if you still find yourself dedicating resources to dealing with paper…we can help you out.


Rob Fea spent 12 years partnering with IT teams and clinicians at major hospitals and clinics worldwide during his tenure on the technical services team at Epic. Rob supported Epic's Phoenix product, playing a major role in project kickoffs, installation, data conversions, ongoing support, and optimization. Rob watched the Phoenix customer base expand from 0 to 55 live and installing transplant organizations. This experience gave Rob expansive insight into the healthcare world, especially the solid organ transplant industry. Rob has spent countless hours on the floor in transplant departments observing multidisciplinary visits, committee review meetings, data entry, data trending, reporting, medication dosing, and more.