EMR switching? The second wave.

I want to reference today a great discussion by John @ EMR and HIPAA, EMR Switching Encouraged by Meaningful Use. My colleagues and I have long believed we'll see a second wave of software purchasing (switching) driven by usefulness, or what one commenter called "functional disappointment".


First-wave buyers are often driven by easy-to-assess factors, such as screen appearance or price. Coming from paper, we may be satisfied to see during a demo that the software covers the expected items, i.e. the checklist you have on your paper exam form. After that, if the software is certified, it's easy to conclude that "it must be good". Throw in a big name and a low price and you're ready to make your leap of faith.


Second-wave buyers are ready to look deeper. You may already have experienced this with your cell phone, car or house. My wife and I bought our second home not because the first home didn't have everything on our checklist but because of missed criteria we did not have on our checklist the first time around.


What are those missed criteria for EHR buyers? Without attempting an exhaustive list, here are some things to consider:
1. Meaningful Use is for the government; usefulness is for you. Buy for both.
2. We're moving from recording results to "improved patient outcomes". That means software has to be smart.
3. "Smart" starts under the hood. If the software doesn't show evidence of a robust rules-based engine, look elsewhere.
4. All software programming uses rules to a greater or lesser degree, so engage some qualified IT people to advise you on what's under the hood. 
5. Remember that cloud computing is a delivery method not a software guarantee. While there are good things about browser-based solutions, they can still be seriously underpowered in their decision-driving capabilities.
6. As we move to stage 2 of meaningful use, communications will be the litmus test. I believe that in stage 3, clinical decision support will be the final test. This is where "smart" will emerge from under the hood to the surface and where the inferior solutions will fall by the wayside.
7. The stages of meaningful use govern phases of certification. These phases do not limit vendors from releasing useful functionality today. Therefore, look for signs of advanced communications and clinical decision support today.


Alistair Jackson, M.Ed.