By: John A. Hovanesian, MD, FACS
Believe it or not, it’s only been 15 years since the use of electronic health records became common in the U.S.
Many of our early-career colleagues grew up in medicine with these systems already in place and never experienced the challenges of starting to use EHR when these systems were not really “ready for prime time.” It’s still not easy using EHR; inputting patient information into a computer is far more laborious than writing it on paper, and the EHR systems have not become more streamlined over time. Nonetheless, EHR is now essential to our practices, and any new digital tool must somehow fit in with our use of EHR. This creates one of the biggest barriers to success with new but valuable offerings.
Many great tech ideas have been developed to streamline our surgical planning, interact with and educate our patients, help us manage financial transactions, evaluate digital images and even use AI to scribe our visits with patients. But the more closely these systems must interact with EHR to deliver value, the more challenging it is to make them work. Most EHR systems were not designed to be interoperable with separate software systems not developed by the EHR vendor. And EHR vendors generally are not particularly motivated to allow other systems to interact with them. It’s somewhat understandable, given the many challenges they face to ensure security, reliability and privacy. Interoperability is simply one more burden, and helping another company, regardless of the relevance of its offering, just doesn’t make the priority list.
I know firsthand how hard it is to get cooperation from EHR companies. In 2013, I founded MDbackline, a stand-alone web-based software that was eventually sold to Alcon for integration into its digital platform. MDbackline was designed to streamline communication with patients, and every doctor who heard about it was excited to use it. At that time, though, few EHR companies had established application programming interfaces (APIs) to allow interoperability. Today, those same EHR systems still offer only limited API functionality, often with high fees for use. That leaves the small start-up to find workarounds that may or may not violate EHR software agreements and may pose a risk to security.
This challenge is faced not just by small technology start-ups. My conversations with leadership at our largest drug and device companies have shown me that they too face these same obstacles when trying to secure cooperation from EHR vendors. We simply have a broken system in which the advancement of digital technology takes a backseat to other mandates facing EHR vendors.
The challenges for implementing a new digital solution don’t stop there. The biggest barrier in a medical practice is human inertia. Whatever workflow we follow every day eventually becomes the status quo, and we defend it vigorously. Much resistance meets anyone introducing a new step, even when it yields high value. If a new process requires cooperation from many members of the office staff, each one has veto power over its success by choosing whether to follow the new process. For a digital company trying to bring forth a new process to help patients, these human challenges can be insurmountable.
That’s why we physicians need to be the champions of digital innovation in our practices. We need to put pressure on our EHR vendors to allow interoperability, and we need to educate our staff and continually coach them to embrace rather than obstruct the new technology.
It’s promising to see new platforms like the augmented and virtual reality systems that may change the future of medicine. So many of us love a new gadget, but the closer these gadgets get to working with our base EHR system, the more challenging can become their realization. We physicians need to do everything in our power to enable them.
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