To Solve EHR Problems, It's Time to Get 'Real'Published on
Physicians Practice (http://www.physicianspractice.com)
To Solve EHR Problems, It's Time to Get 'Real'
Blog [1] | April 13, 2015 | EHR [2], Health IT [3], Physician
Productivity [4]By Daniel Essin, MA, MD [5]
Like every computer system, each EHR creates its own virtual
reality. The danger stems frommistaking this "virtual" reality for
actual "reality." Source: Physicians Practice
Virtual reality (VR) brings to mind people wearing 3D goggles
and special gloves and playing "Call ofDuty" or having an
"immersive experience" flying like a bird.
VR is able to create simulated worlds because within a computer
program, it is possible to rewritethe rules and even ignore the
laws of nature. All that is needed to enter a virtual world is to
suspenddisbelief. The essence of VR is not the goggles, gloves, or
fantasy. It is the acceptance of an arbitraryset of goals, rules,
challenges, and interactions. These tend to be rigid because it's
simpler.Flexibility is not necessary in a virtual world. Rules
exclude the unwanted and the unexpected issimply ignored and
thereby, disallowed.Why mention VR? Because inside every computer
system lurks a self-contained environment thatoperates on basis of
arbitrary goals, rules, challenges, and interactions. That is the
definition of avirtual world. Ideally, reality intrudes only
occasionally; and if you believe that, I have a bridge forsale
...Rules can detect and respond to definable situations. They
cannot detect the unexpected; if it waspossible to formulate such a
rule, it wouldn't be totally unexpected, would it? Sometimes, like
a bankstress test, the unlikely can be simulated but the truly
unexpected. The "Black Swans"(a term coined by statistician Nassim
Taleb) catch every rule engine, and most people, off guard. Ina
game, the "fun" comes from contending with, and succeeding in the
face of, rigid rules butmedicine is not a game.In fact, the
practice of medicine is about as far as you can get from VR. There,
the complete set ofrules is knowable. The "rules" of disease are
incompletely known at best. Illnesses, accidents, andinjuries may
be similar, but they are rarely identical. In medicine, the
objective is not to win bycomplying with arbitrary, rigid rules; it
is to win in spite of the rules, whether they are known or not.This
requires flexibility and inventiveness. Rigidity is frustrating for
physicians and potentiallyharmful to patients.Like every computer
system, each EHR creates its own VR. The danger stems from
mistaking this"virtual" reality for actual "reality." Within the
VR, the rules create work for physicians. The typicalEHR's game
cannot be played without rigid rules. The problem, of course, is
that there can never beenough rules to cover every eventuality and
there are not enough hours in the day to complete the"virtual" work
that the rules generate. Is it any wonder that physicians get
frustrated by activitieslike coding and other "busy work" that add
rigidity and that seem tangential to patient care?Not all computer
systems have this problem. For example, Amazon.com works. The rules
are neithercomplicated nor onerous and people are anxious to shop
and buy, so they opt in and play the game.The worst that can happen
is that their purchase doesn't complete or they end up
withnon-returnable merchandise.EHRs don't work well at all. The
rules are complex, onerous, arbitrary, and artificial. Physicians
havelittle use for them and would prefer to opt out and not play
the game, but most do not have thatchoice.What would be better? A
system that gracefully accommodates the unexpected. The
evidencedemonstrates that the recipe for a different kind of system
has apparently eluded most developers.It certainly has eluded the
esteemed committees that ordained the certification criteria.The
result, according to a recent physician survey: "More than 60
percent of doctors do not considertheir current EHR a worthwhile
investment." As well they should not, for an EHR is not
aninvestment, it is a never-ending expense a sunk cost that will
never increase in value. Its purchaseprice can never be recovered
by selling it because for all it costs, the customer never actually
ownsthe system (software), they may not own their data, and the
hardware depreciates rapidly.What's the solution? Follow the lead
of the Defense Advanced Research Projects Agency (DARPA) by
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To Solve EHR Problems, It's Time to Get 'Real'Published on
Physicians Practice (http://www.physicianspractice.com)
redesigning EHR from the ground up. DARPA "has unveiled its plan
for the future, and its a hugeshift ... the biggest change is its
plan to reinvent complex military systems and make them moremodular
...," according to a recent article in Extreme Tech. Modularity
makes it possible to bettermanage the unexpected because each
module has a narrower scope than a complete system. Thesmaller the
module, the fewer things it must anticipate and address. Those
functions that require orbenefit from rigidity can be isolated so
they do not interfere with others, like charting,
wherepractitioners need the latitude to describe actual events
faithfully and without constraint. Source URL:
http://www.physicianspractice.com/blog/solve-ehr-problems-its-time-get-real
Links:[1] http://www.physicianspractice.com/blog[2]
http://www.physicianspractice.com/ehr[3]
http://www.physicianspractice.com/health-it[4]
http://www.physicianspractice.com/physician-productivity[5]
http://www.physicianspractice.com/authors/daniel-essin-ma-md
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