The chart interface is both bland and busy; a feat the late Steve Jobs would have mocked and likely corrected. Jobs cared deeply about the user interface. This is what made him such a genius. Instead, we are provided with screen setups that ought to be avoided by migraineurs and anyone who comes to work in a sleep-deprived state.
Another major selling point is that these programs are structured so that each patient visit will collate all the requisite data to achieve the designation of meaningful use. There are even warning buttons reminding you of what still needs to be done to achieve this chart nirvana. A host of templates are available for doctors to create notes and—dare I say—even upcode their visit. Although providing a shortcut, which may not be entirely legal, templates also discourage reflective thinking and stifle the creative analysis of the patient’s condition. Its widespread use endangers the art of the medical note (see Rheuminations, May 2012).
All of these new changes are quite demoralizing, especially when one considers that the likelihood of seeing any significant improvements in these systems over the next few years is practically nil. First, there are no great incentives for these developers to improve their products.
Consider the fact that these EHR systems cost hundreds of millions of dollars to implement. Partners took a $1.2 billion charge for theirs.6 There will be little appetite and no money left to install another program. Healthcare systems will be stuck with their purchases.
Second, the ability for Silicon Valley startups to offer innovative modifications to these systems will be limited because most EHR data are stored in proprietary server networks and not somewhere on the cloud. Access is closely guarded. Finally, the sheer scope of moving massive patient networks from one EHR platform to another poses daunting logistical challenges to the institutions and their staff that should be experienced only once in a lifetime.
Lessons from BlackBerry & Microsoft
It has been stated that disruptive innovation most likely occurs when dominant companies become too large and complacent. Witness Apple’s meteoric rise from near bankruptcy to becoming the largest capitalized company on the planet, zooming past its bloated rivals, Microsoft, IBM and BlackBerry. How did it succeed? By giving the customers what they wanted. When asked why BlackBerry, a once high-flying smartphone company, has gone to the dogs, David Yach, its former chief technology officer, said that he learned in retrospect that beauty mattered, fun mattered. “That was so antithetical to BlackBerry. It was aimed at efficiency, security and all the practical things people in the biz world want.”7