by Rick O'Pry
Community hospitals are at an IT crossroads of sorts. For the first time affordability and availability have intersected enabling them to acquire electronic health records (EHRs) as a result of Web-based technology. Because widespread hospital and physician EHR adoption will further patient safety, quality of care and efficiency, and because community hospitals constitute the bulk of hospitals nationwide, community hospitals are key to the digital transformation of healthcare.
However, many community hospital executives still cling to myths that robust EHRs are beyond their reach largely because large, urban, academic medical centers have held the IT spotlight for so long. In the hopes of dispelling these myths and making community hospitals aware that Web-based EHRs are available today, here are collected below some of the widely held myths that have slowed adoption of EHRs among community hospitals. By reconsidering some commonly held assumptions about IT and community hospitals we will be better able to see that the digital community hospital has finally arrived.
- Robust, Web-based hospital information systems are not available to the independent community hospital.
Not true. A new breed of truly Web-based systems is available for the small to mid-sized community hospital that incorporates the standards-based interoperability and functionality required for succeeding in the era of pay for performance.
- Community hospitals require systems equivalent to those used by academic medical centers.
Academic medical centers and large IDNs that are IT leaders have typically developed their systems in-house with large IT departments over long periods of time. Those systems are tailored to their particular needs and circumstances and are not always replicable or even desirable for the typical community hospital. The good news is that it's not necessary for the community hospital to reinvent the wheel. By combining lessons learned by these big hospitals with the capability of new software development tools, it's now possible to design affordable yet sophisticated systems for smaller hospitals.
- Community hospitals cannot afford these systems.
New tools and processes for developing Web-based, thin-client systems have dramatically cut the HIS cost for community hospitals. Add to that browser-based implementation and training and the cost comes down even more, to between $10,000 and $20,000 a month, within the price range of a small to medium-sized hospital.
- All "Web-based" solutions are the same.
Not true. True browser-based systems are built from the ground up. Trying to "cut and paste" a browser onto legacy software code creates obstacles for thin-client technology, which provides the best value for community hospitals. While many legacy HIS vendors continue to cut and paste, developers of true Web-based systems have embraced new "Dynamic Language" tools that support thin client development.
- 100 percent satisfaction guarantees are never going to happen in this industry.
Like many organizations these days, vendors pay lip service to customer satisfaction and the desire for long-term "partnerships" with clients. However, once the sales process is complete, such promises too often fall flat, let alone incorporate anything as radical as a 100 percent guarantee into a written contract. No other industry asks customers to spend millions of dollars only to find that the product is not quite ready, installation takes longer than anticipated and major integration issues loom large. Community hospitals can and should demand "risk share" agreements with vendors, including provisions that they should not have to pay license fees until they are 100 percent satisfied the system is working to the expected level. Don't pay until you get what you were sold. Only a few software companies are willing to make this type of guarantee.
- Wireless mobile communication for physicians is not ready for prime time. Medicine is mobile today and getting more so. Wireless networks are ubiquitous in the business world and are becoming so in healthcare. Physicians love Web-based portability because it fits more into their natural workflow and allows them to have more balanced lives. They shouldn't have to miss a child's soccer game because they are waiting on a lab result.
- To be competitive, you must have a "robust" EHR with full functionality.
Most community hospitals don't have such a thing and may never...and that's OK. An EHR is more a process than a product. While all hospitals should aim for clinical transformation — and an EHR is a key component of that transformation — speed and convenience outweigh elegant features for physicians every time. Go with a basic-yet-fast system and carefully migrate it over time to increased functionality.
- Training is expensive and time-consuming.
A true browser-based system makes training much easier and faster than conventional classroom or onsite training. The proliferation of the Internet into homes has made phrases like "point-and-click" or "drag-and-drop" household terms. And, for the older generation of clinical users not as familiar with technology, there's always the "help desk" of kids to help with training at home.
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