This is the time of year in the east when cinerescent caterpillar nests hang thickly from the trees, peppered tufts of cotton candy. During these long, flavorless August days, the sky is a similar achromatic color. My nine-year-old is concerned because I told her we are having caterpillar soup for dinner tonight—watch out for the crunchy bits. Once again, it seems I’ve gotten off message.
I wonder how much of the difficulty surrounding EHR has to do with getting off message, much like we seem to have done with the reform discussion. What difficulties? Got time? You can name more of them than can I.
What is off message? It’s that the day-to-day tactics of implementing EHR office by office, and hospital by hospital have overshadowed the strategy, have displaced the business driver behind the mandate. The focus became internal, not national. Bits and bytes have overshadowed charts.
I doubt few, if any, can articulate a believable explanation of how a few years from now your medical records will accurately and expeditiously be delivered from where you live to the lone clinic on Main Street, Small Town, USA, to the nurse practitioner who at midnight is giving you an EKG.
It’s that fact, that we are not able to define how we get from A to B, let alone do so with multitudes of A’s and B’s, that to me suggests we are building something of which we have little comfort will do what we set out for it do.
Clearly, there are hundreds if not thousands of very talented and dedicated professionals focused on finding a solution. However, it seems their efforts remain handcuffed by hundreds of competing products, no well-defined overriding set of requirements that would enable anyone to say with certainty, “Yes, that is it. That captures what we need to do. When we have done that, we are done.”
Until that time, I think we all need to be concerned about the crunchy bits.
What do you think?
Well said Paul. Successful implementation of a single EMR is akin to making it to Carnegie Hall, but no one comes to see hear you play. Unfortunately, like many other parts of our medicine, we are now simply following the financial incentives. Get those “meaningful use” dollars, even though most implementations will likely end being only modestly useful and not terribly meaningful in the grand scheme of things. Without a real framework, I fear we are doomed to a lot of crunchy bits for some time to come.