EHR Lessons from Unexpected Sources

February 11, 2013

It is time to stop repeating the worn out rhetoric that existing EHRs …are going to come to the rescue of medicine, patients, or healthcare costs.

Recently, Medscape reproduced an article that presents several lessons that, if taken to heart, might accelerate the development of "you fill in the blank." I'm going to put the citation in a footnote and ask that you not peek at it until you get to the end. That said, I'm going to quote the eight lessons with some wording changes to highlight their applicability to EHR and, if you replace EHR with any other field, their generality.

1. Paradigms change, and "expert" opinion can be wrong. Maintain an open mind and dare to explore innovative approaches that may not conform to current scientific orthodoxy.

2. Basic science is essential, but it alone will not be sufficient to develop an [EHR]. Science needs to be translated into products for clinical evaluation.

3. [Results from actual use of EHRs] trump everything we [believe the benefits of EHRs "ought to be"], and we need to be prepared to expect the unexpected. Even a small number of endpoints [derived from actual EHR use] can provide important information with which to generate hypotheses for further scientific evaluation.

4. As there is more than one way to develop [EHRs], and no guarantee that any one will work, different concepts need to be tested in parallel.

5. [Existing EHRs] can [provide some benefits that may be significant], but new tools (especially new EHRs]) are needed [before the problem can be considered to be definitively resolved].

6. [EHR] development does not exist in a vacuum, and its importance needs to be understood and supported by society. Sustainable political support over the long term is needed in order to build on current modest successes. Government funding and activities would benefit from the comparative advantages and flexibility of nonprofit and philanthropic organizations.

7. Invest in the future by protecting the funding necessary for [EHR] development, perhaps up to 10 percent of total [expenditures on EHR].

8. Preparation for success can shorten the time between the development of an [EHR] and its widespread use in … health programs. [Existing EHRs have not, so far, saved billions of dollars or millions of lives. It remains to be seen whether a radically different EHR can do so.]

It is time to stop repeating the worn out rhetoric that existing EHRs, based on 35-year-old technology and concepts, are going to come to the rescue of medicine, patients, or healthcare costs. If they could, they would have done so by now.

For the country at large, EHRs still represent a gamble. Everything that behavioral economics has learned about how people make decisions applies here. It is time to replace the collective lust for an EHR that lives up to our science fiction-inspired expectations with a more practical approach based research, thought, rational action and appropriate funding.

Source: José Esparza, "Lessons From Polio That Could Inform the Development of an HIV Vaccine"