Practice Wise 6/9/14

There is no perfect software

Dear Doctor,

I really do understand your plight. It feels like the EHR is ruining your work life. You were not a day-to-day business software user until the advent of the EHR. It’s seemingly been dumped on you from on high, been made a big part of your day-to-day practice, and is probably something you didn’t want. The hardest part of this transition for you is to accept that nothing charts exactly how you think it should, because there is no perfect software. It takes a lot of effort on your part to make it work for you.

Hopefully, I can help you understand the complexities of EHR software in the same way my internist tries to explain to me the complexities of my middle-aged body and its various aches and pains.

True story: (Sorry for the TMI, but this is a concrete analogy.) I complained to my internist of pain in my left upper quadrant several years ago. As my diagnostician, she had many systems to consider as the source of the pain. There’s my musculoskeletal system, GI, cardiovascular, and so on. To rule out each of these systems as the cause of my pain, she took a history, palpated the area, and ran diagnostic tests that included blood work and imaging studies. When she still couldn’t figure out what was causing my pain, she referred me to one or more specialists. At that point, I started this process all over again, giving history of present illness, having full physical exams, and even more studies. Each doctor I saw had a different take on what was causing my pain and how to alleviate it. They depended on my willing and collaborative participation to figure out what was wrong with me. We travelled a road of trial and error together.

These things are not always immediately evident or clear cut. As the patient, I’ve not yelled at my doctors or the people doing the testing. I don’t threaten to sue my primary care doctor for not curing me on the first visit, or for referring me to other doctors that cost more money and still didn’t solve my problem. I understand that each provider is doing the best they can with the tools they have to find the correct answer and offer me a solution. Recently, the solution from my PCP was “Sometimes as you get older, things change and feel different and hurt, with no known etiology. You’ll to have to accept it, get used to it, and live with it.” I took it at face value and thanked her for her efforts.

Could you even imagine if you called your software company with a problem and they told you to live with it? Well, sometimes that is the answer. Usually, hopefully, they will try to develop a solution to your issue (if it is a real issue and not a user-interface issue). Sometimes the user is actually causing the problem – like your patient who is non-compliant and still wants to blame you for their woes.

When you call your EHR support company and state that something is not working, please realize there are underlying systems involved in what appears to you to be the single function causing you pain. First-level support has to triage the urgency of the issue, take a history of the problem, palpate the system, consult the literature, try a cure or two, and possibly escalate the case to a specialist. That support specialist may have to ask you further questions about your experience, continue to trouble shoot, and test solutions. If they can’t fix it, they send it up to development as a bug. The development team takes all bugs very seriously and works on them in a queue based on priority. Although the issue is your top priority, you may be the only one affected by this bug. They may have other bugs that affect a greater number of users, or reduces the functionality of the software in a more significant way. It’s the difference between an isolated stomach ache and a salmonella outbreak. They address the most critical issues first.

This is really no different than a doctor sending a patient out for referral and diagnostic studies when they don’t have the answer. Threatening to sue your vendor when something goes wrong is not an impetus for them to get it right. The impetus to get it right is already there. It’s their job and livelihood to keep customers working in their EHR. Cursing and name calling are also not exactly positive motivation! You wouldn’t consider having a patient treat you this way when you don’t provide an immediate cure.

At least once a week I hear someone say something like, “My spreadsheet program graphs better,” “My email does messaging better,” or “My document editor does that perfectly with spell and grammar check (amazing how many smart people absolutely rely on spellcheck!).” Each of those programs is basically a single-function product. The EHR has features embedded in a complex program that does a thousand times more than that single product. It’s just not that simple! I know that frustrates you, the end user, but it is what it is. Just like my flank pain is not that simple. It’s like me comparing my body to a perfectly fit 20 year-old. It’s not reasonable.

There is no perfect software, just like there is no perfect body. It’s all highly complex and variable. If you can realize that software development and support is a lot like practicing medicine, maybe you’ll be more comfortable with your new reality. Your vendors want your constructive feedback and input. You are the end user, and your day-to-day experience with the product is the most valuable diagnostic and improvement tool they have. Your patients are the best at healing when they collaborate with you in their care. Your software issues are best resolved when you collaborate with your vendors.

I have encountered quite a few physicians and allied health professionals who want me to help them find the perfect software because the first three they tried were all bad. My suggestion is always to look at the entire situation. If they can’t succeed with any product they try, maybe it’s time to take stock of what the common denominator is. Maybe they are unlucky and/or make poor purchasing decisions, and they’ve actually gotten three rotten apples. More likely, however, is that they don’t understand what their role is in making software successful in their practice, so they’re not giving the software a chance to actually work. If they’ve been through three products in four years, and the changes weren’t caused by product acquisitions, etc., then I tell them to take a long hard look at themselves. They need to honestly evaluate their expectations of the software against their willingness to make it work, and then be willing to do the work necessary to be successful. Before throwing the software out yet again, call on a consultant who is an expert in the field who can help determine if the user(s) or the software/vendor is the problem.

Again, assume I am talking about those good vendors who do care about their product and the EHR users who keep them in business, who make a strong effort to provide the best possible product and who respond to your issues. If my doctor blew me off and didn’t address my pain, I’d find another doctor. Thankfully, I have a good doctor, a collaborative relationship, and a pain in my side that we can’t figure out. It’s not her fault. I have faith that in time I’ll learn to live with it.

I hope that you too will learn to live with your software, and even embrace it!

Sincerely,

Your EMR Consultant

P.S. I’m open to a curbside consult!

Julie McGovern is CEO of Practice Wise, LLC.