Monday, November 21, 2005

Reinventing the wheel, with a touch of deja vu all over again

In 1998, I authored a website that described the real-world problems of implementing electronic medical records, up to and including outright failures, in clinical settings. These problems included software design issues due to leadership of design processes by non-clinical personnel, conflicts requiring flexible leadership styles fitting the scenario, territorial problems, unhappiness that software only made clinicians' jobs harder, etc.

I am unhappy to report that things have not changed much in the past seven years. In the BMJ article "Kaiser Permanente's experience of implementing an electronic medical record: a qualitative study", the findings are as follows:

Seven key findings emerged: users perceived the decision to adopt the electronic medical record system as flawed; software design problems increased resistance; the system reduced doctors' productivity, especially during initial implementation, which fuelled resistance; the system required clarification of clinical roles and responsibilities, which was traumatic for some individuals; a cooperative culture created trade-offs at varying points in the implementation; no single leadership style was optimal--a participatory, consensus-building style may lead to more effective adoption decisions, whereas decisive leadership could help resolve barriers and resistance during implementation; the process fostered a counter climate of conflict, which was resolved by withdrawal of the initial system.

Shall we accept this as a non-preventable model (which includes significant wasted capital, ultimately, although one person's wasted capital is another's profit) for the thousands of hospitals and hundreds of thousands of clinicians who are supposed to adopt EMR over the next decade or two? Or is someone going to identify the problems and do something about it?

I am not hopeful.

-- SS