Right Answer, Wrong Question- New CIO EHR Survey

New Survey- “CIOs Say Usability, Search-Related Problems Prevalent Among EHRs”

iHealthBeat reports on new Frost and Sullivan survey focused on CIO EHR perspectives. I believe we need to refocus today’s EHR dialogue on the many benefits EHR provides- this vision seems to be missing. We are playing catch-up to many countries who have embraced EHRs. Survey highlights and summary of my comments posted on iHealthBeat http://www.ihealthbeat.org/articles/2014/10/27/cios-say-usability-search-related-problems-prevalent-among-ehrs . I see many parallels between the e-commerce revolution in the 1990’s and today’s EHR debate. Copy of my unedited comments below.


Right Answer, Wrong Question…

Asking CIOs how they feel about EHR’s, you would expect comments that today’s EHRs are challenging, slow, and have operational problems. That is the right answer, but in my view the wrong question. While the information gained provides insights into perceptions, the more important question to address is from the CIO perspective, what do they see as the most immediate EHR applications they need to change and/or enhance their current operations, including meeting ACA guidelines and improving their cost/performance benchmarks. What I am suggesting is let’s move the discussion to focus on specific process enhancements that EHRs will drive. My thinking is driven by what we saw in the e-commerce market evolution.

E-commerce, new electronic services that displaced paper, was a driver of the Internet revolution in the late 1990’s. Many saw the vision that cost/performance benefits, not paper or admin cost reduction was the real driver here, but we faced formidable challenges, e.g., lack of standards, privacy, multiple technology platforms, training issues, complexity compared to ‘simple’ paper forms, and others.

From my perspective, sure sounds like exactly what we are facing with today’s migration to EHR. So looking back, what did we learn and what does experience tell us about today’s EHR “revolution.” I see three key directions based on my experience.

First, e-commerce winners understood that changing process, not solely displacing paper, was the key benefit. For example, using electronic purchase orders rather than paper saved paper and admin costs and were more efficient, but they also enabled analytics to optimize supply chains and improve profitability- that could not be done with paper. This was a key point driving e-commerce revolution which myself and others reinforced, i.e., “implementing e-commerce systems will cost more, but you will achieve cost and operational efficiencies and improve your competitive position.” This was not accepted by all at the time. Key point here- today’s EHR’s may cost more but they don’t just automate paper-based record keeping- they really open the door to create new processes and dramatically reshape healthcare. That is the message we should be reinforcing backed up with solid cost- effective applications.

Secondly, new e-commerce applications emerged and many new ventures were spawned contributing to e-commerce market growth. And these were entrepreneurial ventures, targeting sectors and all value chain functions to improve operations, e.g., supply chain management, distribution channel optimization, marketing analytics, and so on. Market growth at the time was fueled by venture capital and creative entrepreneurs, not the major firms. In today’s EHR environment, expect to see many new ventures accelerate in areas of remote telemonitoring, predictive analytics, and others- healthcare is a significant target, long overdue for major cost performance step up, and EHR is the accelerator to make it happen. VCs in my view are still behind the curve here but I believe approaching a critical mass here.


Finally, e-commerce was a global business and, at the time, many new technologies and e-commerce structures emerged overseas. Today, recognize that many countries have EHR adoption rates greater than 90 percent, and we are playing catch-up with EHR adoption at less than 70 percent and CIO resistance based on the survey . In these overseas markets today, EHR is embraced and driving new applications, analytics, and solutions which I expect will play a role as the US market for enhanced EHR achieves what I believe will be exponential growth in the next decade.

Paul B. Silverman writes about entrepreneurship, healthcare, analytics, and strategy management and serves as Advisor, Speaker, Educator, and Managing Partner of the Gemini Business Group, LLC, a new venture development firm, and author of “8 Building Blocks To Launch, Manage, And Grow A Successful Business.” He also serves as Adjunct Professor in the School of Business at George Mason University. See more at Paul B. Silverman Blog and sign up for Entrepreneurship Today! email updates to track latest new venture developments.

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