The Geek Index, Geek Threshold and the Problem with Today’s EHR

August 8, 2011

Even if physicians are influenced by the incentive or social pressure to make a purchase, the real test will be what, if anything they are doing with their new EHR a couple of years down the road after the initial excitement wears off.

I have coined a term - The Geek Index - to express the degree to which arcane knowledge that is acquired by word-of-mouth or mind-reading is necessary to make a product work. There are some people that have a better than average ability to guess what other people are thinking. Others have photographic memories and can learn a complex task in one “take.” Some have more interest in the workings of a device than in the task that the device was designed for. These people live in a rarefied world which baffles the rest of us. 

Lots of things have a high Geek Index, not just computers. The clock in my VCR had a high index so I put a piece of electrical tape over the display to hide the flashing. Cars used to have much higher indexes than they do now. My uncle used to dive into the engine of his 1956 Porsche every Saturday to physically install larger jets in the carburetor before his drive in the country (and then remove them before Monday). Now the engine computer compensates for these things automatically. Computers, even the Mac, have an index that is pretty high. Daily or weekly updates, installing software, dozens of possible settings in every program that can determine how hard or easy it is to use, if you understand the settings.

[Even the iPad has a higher Geek Index than I expected. Due to its limitations, many users find themselves installing and tinkering with dozens of apps to get things done that should have been easier. I can't even begin to imagine how high the index must be for an Android device. ]

Then there is the Geek Threshold. There is a level of effort required to conquer the Geek Index. Only the rare individual is prepared to exert this much effort. These people are the Geeks. I know from personal experience. For the average person, if the Geek Index of a product exceeds the Geek Threshold, they give up and never become an actual user.

The reason people aren’t falling all over themselves to use an EHR or any of the other computerized wonder-tools is that the Geek Index of the products is too high relative to their Geek Threshold. It’s simply not worth the time and aggravation. Most people are happier with inefficiencies they know, which have limits that they understand. The typical EHR is at least as inefficient as their paper processes but in addition has the Geek factor that it must be heavily tweaked to obtain the maximum possible benefit. The result is that if you go down that path you are subjected to the high Geek Index. If you don't configure it, then it is probably just plain hard to use effectively, lowering the Geek Threshold. Either way it represents an unknown and potentially endless string of uncertainties and distractions. Many physicians, trying to put patient care first, are unwilling to create a situation is which the technology continually distracts them from tending to the patients.

Even if physicians are influenced by the incentive or social pressure to make a purchase, the real test will be what, if anything they are doing with their new EHR a couple of years down the road after the initial excitement wears off. In the past we’ve observed really motivated physicians can run out of steam after a few years and abandon their computer system. In my personal experience almost 75% of those who made a purchase either: 1.) never completed the implementation; 2.) never got over the initial learning hump; or 3.) they stopped using it after two to three years. Based on this data, even if there is a burst of purchasing activity, the long-term impact may be minimal unless the systems that are chosen have a sufficiently low Geek Index. If using a new system doesn't become second-nature within a few weeks to months, the prospects are dim.

Time will tell.

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