This turned out to be relatable to people who have to use apps like Concur, but especially Electronic Health Record software. Doctors, I feel your pain! EHRs, I’ve learned, make all other enterprise software look like Microsoft Paint. The reasons are interesting and depressing.
BTW, here’s why I know anything at all about this: medical groups get pitches from blockchain companies claiming to fix EHRs 🙄 They sometimes call me—I teach blockchain tech—to ask if this makes any sense. I’ve used that as a chance to learn why EHRs suck in the first place.
To start, everything I said about Blackboard applies to EHRs: the people doing procurement are far removed from medical practice and evaluate them based on checklists. But there are at least three other factors that push EHRs into their own circle of hell.
In most industries, "top-down" enterprise software competes with "bottom-up" alternatives like Slack. These are adopted directly by users, bypassing traditional procurement, so they prioritize usability. But not in healthcare—you just can’t sell EHRs directly to doctors & nurses.
Second, since healthcare is heavily regulated, many design decisions are driven by compliance. Turns out the easiest/laziest way to try to ensure HIPAA compliance is to get in the way of doctors sharing patient info with the patient and with each other.🤦
Third, the complexity of EHRs blows up due to things like billing that hospital administrators care about but are unrelated to patient care. From what I’ve learned, administrators have so much power that they are able to get away with pushing this burden on doctors!
A better approach would be to bring in data entry specialists to handle the necessary complexity of EHRs and protect doctors’ time. There are many horror stories of doctors doing data entry on evenings and weekends, and even quitting due to the EHR burden. nakedcapitalism.com/2018/01/highly…
These structural issues are fascinating. In comparison to doctors, tenured university faculty have far more autonomy (the shabby treatment of adjunct faculty is a topic for another thread). Can you imagine Blackboard being so terrible that professors just quit?!
Here’s the lesson for tech startups. Many things that look like technology problems… aren’t. Look for deeper structural reasons why things are broken, and see if you can alleviate those root causes. Otherwise your attempts at disruption will likely run into the same barriers.
Finally, a shoutout to my primary care doctor from 2012 who first got me interested in learning why EHRs are so evil. On my very first visit, as soon as he heard I’m a computer scientist, he launched into a ten minute rant about EHRs while I sat there shirtless and confused😁
