This occurred to me while listening to a report on NPR that was comparing the Kindle to the iPad.  The comparison made regarding a study conducted to assess the viability of using the devices in universities as e-Textbooks instead of paper textbooks.  The Kindle was tested for a year; the iPad was tested next.

The traditional textbook prevailed over the Kindle; iPad may have reinvented the textbook.  A winner and a loser for what many consider being the same device in different packages.  Apple did the same thing for MP3 players and the cellular phone.

The conclusion about that Kindle was it was a bad imitation of its paper counterpart, saying it was simply a copy of what was on the paper but not as effective.  To me, this sounds like the conclusion many physicians have made about their EHRs—a poor automation of a poorer set of processes.  This is why user acceptance has been poor and why in many places productivity has fallen off the charts.

The study concluded some of the issues with the Kindle for both the students (think patients, and the professors (the physicians)—the analogous EHR function is noted within the parentheses has the following negatives.  The Kindle:

• is less interactive than a piece of paper
• does not follow the layout of a textbook or the flow of the discussion (navigation)
• cannot easily handle full color illustrations and photographs (imaging)
• is more difficult to annotate (SOAP notes)
• takes longer to load the material, input data, and to search for information (clicks and drop downs)
• the users stopped reading Kindles as scholarly texts and began reading them as novels (how physicians read and chart)
• the students learned less and required additional time to learn the same amount (productivity)
• did not maintain pace with the discussion or activity (process)

The textbook winner, the iPad, creates multimedia functionality out of a book.

Just because you search for electronic book readers online, and up pop both the Kindle and the iPad, does not mean they are equal.  You cannot expect a search engine to distinguish between them.

Here’s the punch line.  Just because you Google EHRs and get a list of vendors does not make them equal.  I know you know that.

I think most of EHRs are equal, equally dysfunctional.  Sticking with the analogy of the Kindle and the iPad, most EHRs are Kindles.  Most EHRs—in fact almost all of them; 99% of the 400—are to healthcare what Kindle is to textbooks; not much.  For many, the chart is better.

If you already implemented EHR you learned your EHR, how well is it performing?  I am willing to bet more than half have not met expectations, or expectations have been lowered to meet the performance.  Let us look at the same scorecard we used above.  If your EHR…

• is less interactive than a piece of paper
• does not follow the flow of the patient/doctor narrative
• cannot easily handle full color illustrations and photographs
• is more difficult to annotate than a paper chart (SOAP notes)
• takes longer to load the material, input data, and to search for information (clicks and drop downs)
• does not allow doctors to review notes and images the way they read charts
• requires additional time to read and document the same amount of information than paper charting (productivity)
• does not maintain pace with the patient discussion or activity (process)

…you have quite a mess on your hands.  If this makes you a little weak in the knees, what does this type of performance imply about your chances of meeting Meaningful Use?  Having a certified EHR will not make these problems disappear; you will simply have certified problems.

If you disagree with this assessment, please tell me why.  If you agree with the assessment, what are you doing to try to fix it?  I am willing to bet you a bag of licorice that it will not make things better.

Those who have read this far did not need to read this to know your EHR has not done what you needed it to do.  The strange thing is very few know what to do about it.

Those who have yet to complete their EHR or have yet to begin the process will come to the same conclusion unless they find the hidden jewels that make up the one percent of EHRs that actually function better than a paper chart.