Nice post on TempDev.
Who Should Conform: You Or Your EMR? encapsulates in one pithy question, the essential nature of the IT dilemma at the provider level.
Usually, it takes a more direct form: Why the hell should I conform to the EMR system — the machine — when it’s the proper role of technology to make my life easier?
Who’s the boss here, anyway?
The answer, of course, is that you’re asking the wrong question.
Everyone’s The Boss
There’s no question that you, as a healthcare provider, are more important than the thousands of lines of software code.
In an ideal world, the system would conform to you, and your office mate, and your colleague across town, seamlessly and instantly, no matter how different your practice styles were.
In the real world, an EMR system comes “out of the box” a certain way — hopefully, close to the way you practice. It’s never a perfect fit, however, so someone has to tweak it to fit your particular needs, like a tailor. That’s going to be you, your tech support, or both.
As I’ve alluded to in previous posts, EMR systems are complex beasties. They have to be, in order to perform the myriad tasks demanded of them:
- prescribing and e-prescribing
- documenting patient visits
- ordering labs and radiology studies
- referring to your cadre of specialists
- inter and intraoffice messaging
- handling phone calls and email-type communications
- and so on
Doctors are complex beasties, too.
Admit it: do you practice in exactly the same way as your same specialty colleague? Use the same verbiage, refer to the same people, order the same labs for a given condition, follow-up patients with the same frequency?
Every doctor on earth wants an EMR to conform to their weird demands individual peculiarities (it’s called “customization”). Every EMR vendor in existence wants to sell a system accommodate every single doctor and medical practice (it’s called “market share”). What could be more natural than a mismatch?
Who gets to be the tie-breaker?
Usually The MSO, Sometimes The Vendor, But…
If you’re lucky, you’ve got an MSO or a healthcare management group on your side, updating your software, maintaining your servers, and otherwise letting you focus on the practice of medicine. The MSO will also tailor the system to better fit you, adding certain options, hiding features you don’t use, etc.
If you’re very lucky, if that’s the right word, the vendor will do that adjusting and tweaking for you.
For the sake of argument, assume that the tweaking and tailoring is being handled well by whichever organization.
Who’s the boss, really?
- You? The nominal raison d’etre of the whole enterprise, Dr. Fron T. Line?
- The MSO/vendor? The ones juggling all those incredibly numerous, complex interlocking lines of code?
If you say “Jump!” shouldn’t they say “How high?”
If they say “Can’t do that, it’ll take months and hundreds of thousands of dollars,” should you say “Okay, just thought I’d ask?”
Bottoms Up Wins Over Top Down, Always
If you’re looking at things from the standpoint of a doctor, who needs and therefore expects, demands that the system bend itself to your will, you’re seeing matters from a top down viewpoint. This is how things should be, it’s the principle of the thing, this is a matter of right and wrong. Your way, of course, is the right way, and everyone who isn’t helping you is an evil minion of Darth Vader.
The bottoms up viewpoint is much simpler, and less prone to argument or discussion over matters of philosophy, ethics, or epistemology.
Who’s the boss? He Who Can Kill The Project, that’s who.
If the infrastructure of the practice implodes, everybody loses, end of line.
That’s Okay, Pa, We’re Gettin’ Hitched In The Morning
Something they didn’t tell you, when you signed on for your EMR: you were getting married.
For better or for worse, in sickness and in health, you will be joined at the fingertips, for 8+ hours most days of the week, for the rest of your clinical lives.
So, you can do things the hard way, or you can do them the shoot-me-now way.
Nobody said it would be a cakewalk — melding an EMR and a medical practice takes work and constant upkeep. There are ways of making things easier, but get over yourself, already. Sitting smugly in a corner and telling your MSO/vendor that they’re just not getting it right, it’s their job to make the system lick your shoes, is about as helpful in this partnership as it would be with your spouse. And will end just about as badly — for you, your MSO/vendor, and your patients.
Luckily, both you and your MSO/vendor have a lot at stake, and are thus motivated to make things work (especially with an MSO that exists to support practices).
Who should conform: you or your EMR?
Both of you, of course, to do whatever it takes for great patient care while preserving your sanity.
You’re not trying to win first prize in the fingerpointing contest. If the practice flies apart, no one will care “who was right.”
