▪ What A Difference A Letter Makes...

Over the past few years medicine has witnessed Healthcare IT companies re-name their Electronic Medical Records (EMR) as Electronic Health Records (EHR), and then market them to physicians as new and improved. Countless EMR companies have followed suit, and now just about every vendor is calling their EMR product an EHR, as if the "H" implies something better than the “M” in Electronic Medical Records.

At first glance the letter change made sense. The argument followed that "Electronic Health Record" is more inclusive than "Electronic Medical Record", benefiting not only doctors, but patients, insurance companies, and not to mention the government. The word "medical", implies a tool designed only for doctors, nurses, and clinical staff. Proponents of EHR argue that the tool should not just benefit doctors, but should address varied healthcare stakeholders: patients, insurance companies, government, pharmacies, and other interested parties.

From the vendors perspective, the physician is only one player in the healthcare "ecosystem", and the EHR is a neutral communication tool. In addition, vendors of EHR believe that if they make software beneficial to third-party payers, then these outside interests will select and pay for the software and then push it on "resistant" physicians. Indeed, this is happening today at your Hospital and IPA.

But what about physicians?

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 ▪ EHR, Pay for Performance, and Outside Interests

Underneath the letter change from EMR to EHR there is a subtle implication that the new tool will serve to "keep doctors in line", so you will practice more cost-effective medicine, as dictated by the EHR stakeholders. Just ask yourself why insurance companies have invested so heavily in Pay for Performance (P4P) schemes. Could it be because they are looking out for your best interests to help increase your clinic's bottom line? Unlikely!

There is something very serious behind the single letter change.

 ▪ Computers are far from objective

Often, people make the false assumption that the computer is an objective, neutral machine. Unfortunately, this misperception has helped persuade some doctors to accept the notion of EHR, as opposed to the more focused Electronic Medical Record.

Software, by design, is fundamentally biased by the interests of those who produce it.

Therefore, it makes a considerable difference whether you use a physician-focused Electronic Medical Record, or a stakeholder-focused Electronic Health Record. As a clinician, you have far different priorities than an insurance company, and you deserve software that responds to your needs and to the needs of your patients. Insurance companies have powerful software, including P4P systems, designed to lower their costs and maximize their revenues, often at your expense and that of your patients. That's good for them. But, they don't need your EMR as well.

All computer programs take sides, and a good EMR should take your side as a provider.

 ▪ Interoperability Benefits Everyone

Think back to the famous 1984 Apple half-time Super Bowl commercial, which literally launched Apple Computers. It best illustrates the question at hand: Will the computer be a liberating tool, or will it instead serve as "big brother," keeping you and your colleagues in line?

Today, a better alternative to the EHR "one program-does-all" approach is interoperability, also known as "interfacing". This is where computers excel.

Computers are perfectly equipped to interface on your behalf, and most of the time they can do so faster and with more efficiency than you ever could. When programmed correctly, a computer can be a powerful assistant to your mind, overseeing the myriad of daily tasks you need accomplished in order to take better care of your patients.

 ▪ Software cannot be all things to all people

Software cannot be all things to all people. This is what the misguided voices behind EHR forget. You focus on your patients, and often this means battling with an insurer. Good for you! Could you imagine also battling your with EHR?

There is always compromise, but any compromise ought to take place at the negotiating table between doctors, medical societies, insurance companies, and other interested parties - and never in the programming of a software application. EHRs, produced by those who cater to multiple interests, do not always serve the best interests of medical providers, or the best interests of their patients.

An EMR should work only for you and for the patients you serve.

This is what Praxis is all about.

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