MY EMR Isn’t As Easy as iTunes

This is one of my least favorite complaints I hear about EMR software: “My EMR Isn’t As Easy as Itunes.” Of course, you could substitute iTunes with Uber, iPhone, Netflix, etc. It’s all the same principle. It’s not quite as bad as “I wish Apple would create an EHR.” but it’s close (Feel free to substitute Google or Amazon for Apple as well). It just shows a real lack of understanding of EHR software.

Here’s an example I recently found on Twitter where a doctor offered a similar sentiment.

Another frustrating day using the EMR–just amazing how nonintuitive Epic is and how much time it wastes.

I did not need 20 hours of iTunes training in order to learn how to download The White Album.

— Bob Esther (@bob_esther) April 4, 2019

Listen, I understand where they’re coming from. EHR software is not the most usable thing in the world. However, it’s a mistake to compare something as complex as EHR software to something as simple as iTunes. Plus, don’t assume that Apple could come down and sprinkle some magic Apple fairy dust and do better.

To address Bob Esther’s point specifically, he didn’t have to have 20 hours of training for iTunes. That’s true. However, he did have to have more than 20 hours of training to safely drive a car. Comparing training to use an EMR to a car is much more comparable than comparing training to use an EMR to iTunes. The EMR is a complex piece of software and iTunes is not. In fact, what a doctor requires an EMR to document is probably even more complex than a car. It’s probably closer to a fighter jet. How many hours of training does it take to fly a fighter jet? A lot. The same is true for EHR software where it takes training to learn to use it efficiently and safely.

I can already hear the doctors saying that they don’t “require” their EHR to do all these complex tasks. It’s all of these onerous regulations and reimbursement requirements that require this complex documentation. That’s a fair point, but last I checked doctors wanted to get paid for the work they do and they don’t want to get themselves into legal and compliance trouble. That means that doctors want their EHR software to facilitate billing and meet all of the required regulations. That’s complex. It’s also why I argue that EHR software is complex and extremely challenging from a usability perspective.

Don’t take this the wrong way. I’m not saying the EHR software is perfect. EHR vendors can do better when it comes to usability and they should. I’m just saying that it’s a completely unfair comparison to ask EHR software to be as usable as iTunes when an EHR is an order of magnitude more complex.

I’m also not suggesting that all of these regulations are great for healthcare. I think we could do some streamlining of a lot of these government regulations and that would free up EHR vendors to finally think about innovation. The EHR regulations have been so onerous over the past 5-10 years that it’s sucked the innovation out of the EHR marketplace. Sadly, I don’t really see that changing.

We are seeing some interesting glimmers of hope. For example, it’s impressive to see what companies like NoteSwift and Nuance (to name just a few) are doing to enable voice assistants to handle some of the documentation burden that doctors currently face. That’s one trend that could take all of the complex documentation that’s required of doctors and does it in the background so that it still meets all the reimbursement and regulation requirements, but frees up doctors from that burden. We’re still early in this development, but it’s getting better every day. Plus, it’s worth noting that this innovation is happening outside of the EHR company.

Should the EHR become more usable? Absolutely. Will it ever be as usable as iTunes? Unlikely. Rather than banging down the doors of EHR vendors to make it more usable, it would be much more fruitful to streamline and remove regulations and reimbursement that isn’t adding value. This will free up the EHR vendors’ time to be able to innovate and make it more usable. Plus, it will allow them to remove many of the clicks that doctors so desperately hate.

In the meantime, remember my piano analogy which explains why clicks aren’t the real problem.