How many people would purchase phones if those phones only communicated with other phones in their household? Would a postal service create sufficient value if you could only send letters within your town? Would the value obtained by purchasing a $20,000 car that included a powerful engine, nice audio system, seats with lumbar support and a great air conditioner justify purchase if, after the fact, you learned that to be able to drive from the showroom to your home, you would have to buy a transmission at an additional cost of $10,000 when your total budget limited you to $22,000 and the salesman knew this at the start?
I suspect that you answered, “No!”
Why are we willing to spend millions on electronic medical record systems that offer similar restricted opportunities? Why does the market not demand that the stated purchase price for an electronic medical record system include the cost of various interfaces necessary to communicate with other applications, both inside and outside the organization, in a language-neutral manner? Why do healthcare administrators accept these hidden costs and the subsequent reality of purchases unable to fulfill organization information requirements after the ink has dried on the purchase contract?
Electronic medical records are one component of the digital bouillabaisse needed to launch us into the digitized future of health care. But absent certain vital components, this disruptive technology will remain pie in the sky—and disrupting to clinical work. Electronic records sold in this fragmented, constrained fashion will be an inordinately expensive way to deliver the value they are capable of delivering for financially struggling healthcare organizations.
And despite initial government help with the purchase of such systems, given that the biggest costs of IT systems accrue after purchase, where will the necessary money for those ongoing costs come from? The US healthcare system has significantly cut its direct care staff due to lack of funds. Moreover, consistent demonstration of sustainable savings and improvements to safety and quality resulting from the use of such IT systems is lacking, especially when deployed in resource-constrained organizations.
Which brings us back to the question of why are we willing to pay all this money yet get such limited return on our investment? If the ‘90’s could be distilled by “it’s the economy, stupid,” then the present might boil down to, “it’s market demand, stupid!”
Those who purchase these systems should carefully consider the terms they are willing to accept…and that means getting healthcare administrators and executives up to speed on enterprise IT concerns, the cognitive science (hence patient safety and care of quality) implications of clinical information systems, the need for user-centered design, etc. It also means rejecting contractual terms that protect IT vendors from the fallout of poorly executed IT products taken to market.
It’s time to raise the bar of expectation so that the systems purchased perform properly and fully at a price that the healthcare sector— especially its smaller, less well resourced organizations—can afford.
Barbara J. Moore is a pediatric pulmonologist and medical informaticist. She is a clinical adjunct faculty member of Northeastern University’s Masters Program in Health Informatics and consults for healthcare information technology companies and healthcare providers.
