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Joel Diamond 2/11/09

February 10, 2009 News 4 Comments

You know that you’re getting old when your kids laugh at your original iPod, calling it an antique. It’s only six years old. My original EMR is a little older than that.

Now that I’m merging practices, I’ll be transitioning to a new EMR. Although it’s probably just the natural progression of being an early adopter, moving to my second EMR adds to my angst about aging in a modern world.  

Learning a new system has been a bit humbling. I can recall the days of my first implementation and the frustration of being out of my groove while caring for sick patients. We are after all, creatures of habit, and transitioning EMRs is not that dissimilar to moving from paper to computer. It also reminds me of the inefficient work-arounds that one accepts over the years.

Sometimes the effort needed to make change seems greater than, what in reality, is merely a minor adjustment in workflow. Designing templates again from this fresh perspective is great, and for those of you who haven’t tried this, I can assure you that the creative process is invigorating. 

Overall, I would report that the good news when learning a new system is that the learning curve is much more manageable. This is mostly due to the fact that, aside from some minor differences in the user interface and some new bells and whistles, the overall user experience has not changed much in all these years. I guess, though, that this is also the bad news.

Contrast the change in the iPod user’s experience over a shorter period of time. In 2004, the first iPod Mini came out, soon followed by the iPod photo (in color!). The tiny IPOD shuffle came out just a year later, which was soon followed by the iPod Nano. The current iPod  Touch was announced in September, 2007.

The popularity of the iPod is clearly due to its continuing emphasis on aesthetics, while making sure that it fits into users’ varied activities and changing lifestyles. Basically, a cool interface, with an ability to easily download endless new apps, has tremendous appeal. Furthermore, the ITunes software lets users seamlessly transfer data between systems.

Now without carrying the analogy too far, can you say the same about  your EMR?

The truth is that as far as gadgets go, EMRs are still geeky and haven’t attained the coolness factor associated with BlackBerries and iPhones. When EMR vendors can reflect the same consumerist mentality, we’ll need far fewer incentives to promote adoption.


Joel Diamond, MD is chief medical officer at dbMotion, adjunct associate professor at the Department of Biomedical Informatics at the University of Pittsburgh Medical Center, and a practicing physician at UPMC.

Comments 4
  • Dr. Diamond should check out the new private practice EMR solution that Alert Life Health Sciences has released. It’s not geeky & It’s super intuitive. It has an interface similar to that of an iPod. I’m sure he would dig it 🙂

  • Your ignoring a significant fact- the change factor.

    Change in a practice is the most vexing problem for an EMR vendor, not lack of a slick user interface and coolness factor. Unless you have witnessed Nurse Ratched, standing hands-on hips, heels firmly planted, ignoring your pleas to at least try the new EMR, to at least consider a training session, you have been involved with only several installs……your own most likely.

    Change in a practice, particularly when moving from a paper-filled to paperless environment, represents a significant threatening factor to the established old guard. For example, Nurse Ratched (if you don’t mind me referring to the battle ax from One Flew Over the Cuckoo’s Nest), ruled her domain because she was aware of everything. Introduce new technology where there is unfamiliarity, and these battle axes feel threatened. They fear losing the keys to the kingdom to some younger….and less technologically challenged…staff member. They might feel threatened with that pimply faced, young nurse’s aid/tech simply based on their ease with using a computer.

    The change factor is least written about, least understood, and quite disruptive to implementation.

    Here’s the test- if the staff member can’t even find time for training……..without even casting a glance at the user interface…..it’s a pretty good indication that the change factor has reared its ugly head.

  • IMO, here are two of the key differences between MP3 players and EMRs:

    1) Market size: Various reports place the total US sales of MP3 players at about $2B in 2006. With a few minutes of Googling I could not find a more recent number. Other reports say that Apple owns about 70% of that market. In 2007 Apple had already sold 100 million iPods. These numbers are huge and the profit substantial. The huge market share that Apple owns also makes it easier for new models to be accepted and profitable. The EMR market does not have these attributes — no one player owns 70% of the market nor are we pushing $3B/year in sales just yet. One research note said that the EMR market was “at $1.8 billion in 2006 and are anticipated to reach $3.2 billion by 2013.” However, this number included sales of “EMR software” to large hospitals and said the average cost per deployment was $1.95M. It would be very interesting to see the numbers of just the physician EMR market size — how does it compare to the iPod market?

    2) The complexity of the data stored and the user interfaces needed are clearly different. I’m sure Apple engineers would successfully argue that they rightfully spent a huge amount of development time creating the iPods and associated infrastructure. Clearly this is very true in the case of the iPhone/iTouch — it is an entire operating system and user experience. Yet is is equally fair to argue that the total amount of data stored, viewed, and archived in an EMR is much more complex. Said another way, the engineers-per-line-of-code ratio is likely very different. Most EMR vendor’s development teams are tiny compared to the number of engineers working on a product like an iPod launch. A Wired article from January this year said that in 2005 “Steve Jobs had tasked about 200 of Apple’s top engineers with creating the iPhone.” Layer on a multiplier for back end support and you’ve exceeded the development staff of even the largest EMR company on the planet.

  • Couldn’t agree with Dr. Diamond (what a great name!) more. There are very few EHR products with a truly intuitive interface (i.e., most have a low ‘coolness’ factor.) I like mine – very ‘eye-friendly’ – but I am always looking around at what’s being developed.

    exCernerite: Alert Life Sciences’ (no “Health” in there) stuff looks pretty cool, but I hate that I have to register just to be able to see the user interface and not just a bunch of Flash, well done as they may be. Have you used it? – Gregg

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