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What Healthcare, Health IT Can Learn from Amazon.com


Physicians looking for lower healthcare costs and CPOE need only turn to Amazon for the blueprint to success.

It is said that one of the reasons healthcare costs so much is that physicians are unaware of the magnitude of the bills that confront patients. The experts at the RAND Corporation who, back in 2005, were predicting great benefits and huge cost savings, have been forced to admit that the benefits have not materialized and costs have skyrocketed. Then, just recently, the news reported the following:

"Just 27 percent of practices achieved a positive five-year return on investment…, [a] study in the March issue of Health Affairs stated." The article then goes on to suggest that if only practitioners would configure their practices as the EHR demands, they might not have lost money. This challenges human nature. The number of smokers and the obesity epidemic suggest that people find it hard to reconfigure their habits.

Then came the second "surprise": "Two-thirds of respondents [to a survey] said finding the right workers with the right skills is the hardest part of successful EHR implementation." What this means in simple terms is that current EHRs are so complicated to implement and use that there aren't enough people available to do the work nor will clinicians devote the large amounts of time required to either get "trained" or use these overly complex, poorly designed systems.

These "revelations" should come as no surprise to anyone who has been following this blog. I've repeatedly warned that these issues would eventually surface and become real problems.

Maybe if the costs weren't so high, the benefit would be easier to obtain. Let's consider one aspect of EHR to demonstrate how a simple function has been made complicated, and how we might simplify it again - Order entry and results reporting / Computerized Physician Order Entry (CPOE). I'm going to exclude e-prescribing because not all CPOE provides e-prescribing, and even if it does, some find it necessary or expedient to use separate e-prescribing applications.

One of the reasons that people shop Amazon.com is that it is easy to compare prices and read reviews posted by others (case reports). It is easy to place an order, track its progress, and receive the merchandise (the results). You can even tell when the product was administered (delivered) to the customer and by whom.

CPOE is little more than a highly customized e-commerce system. It is the customization that makes it both expensive and labor intensive to set up and difficult to use. True, a few orders can get really complex but the majority of things that patients need are pretty simple, as are the instructions for their use. With only a bit of work (perhaps one could even contract with Amazon to perform the work) one could implement CPOE on the cheap by creating a clone of Amazon's Web-based store. Loaded with the available items, physicians could comparison shop, read the reviews, and choose the most cost effective item. Let's call it "Primo" - a bit like Amazon Prime that would provide discounts and other incentives for ordering generic or formulary items. Combine that with a "ship to" list populated with your list of patients and you are ready to start ordering and saving the patients money. Amazon might (hint to Amazon) offer a service to manage your physical inventory, delivering orders directly to the patients, or to your location, the same day. Your out-of-pocket expense for setting up a scheme like this would probably be minimal and everyone (well almost everyone) knows how to order from Amazon.

Is this unrealistic? It may not be as crazy as it sounds. If not Amazon, there are dozens of free and inexpensive applications for creating web storefronts and there must be a programmer somewhere who could be hired to make some modifications for a lot less than the millions to billions that are currently being spent on EHR-CPOE.

Note: Sign up for Primo today, and if you place your order within the next 8 hours and 23 minutes, your web CPOE will be delivered within two working days and the shipping is FREE! Start cutting your patient's out-of-pocket costs today.

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