This is an extremely long article and admittedly I started skimming halfway through, but this statement:
>But we think of this as a system for us and it’s not,” he said. “It is for the patients.”
Is wrong. It's a misnomer to call them medical record systems. They are primarily billing systems. Sure, improving patient care or reducing paper records are nice. But the #1 thing is to document the care to allow them to bill insurance or the government.
Having worked for a company producing software like this, the EHR and Practice Management/Billing components were essentially separate products. Analytics was separate as well. Those were the three big tentpoles, and they would all talk to or depend on each other, but shared very little code and were of course doing completely different things.
You're kind of right though in that it never felt like we did anything because it's what patients or providers wanted. We didn't do things if we were afraid providers wouldn't like it, but a lot of work seemed to be mostly driven by regulatory requirements (meaningful use, icd10, etc.).
I don't think that's entirely accurate. It's true that billing is a core part of most EMRs, but out of the hundreds/thousands of features in a big platform like DrChrono or EPIC, a large portion of them are not billing related.
There's tons of operational utilities like e-prescription, lab ordering, patient problem tracking, vital sign tracking, imaging and diagnostics tooling, etc. You could argue that all of those are somehow related to billing because they help doctors see more patients per day, but billing would still be possible without them, and they largely exist because doctors need them to work effectively and treat patients more efficiently, not because they directly serve the billing pipeline.
Good luck using a piece of paper to e-prescribe a medication such that it's shipped to the patient's pharmacy before the patient even shows up. Ditto for lab orders, imaging analytical tools, custom vital tracking with automatic flagging, diagnostic hardware integration, etc. there is lots of stuff in modern doctors offices that would be significantly more difficult on paper.
Not to mention all the issues of paper management and physical security once you have thousands of patient documents scattered around in filing cabinets.
It's a more generic problem than that. It's that the purchase requirements of the system are not controlled by the users. There are billing requirements, sure, but also regulatory requirements and hospital administrator requirements etc.
The result is that the number of companies offering a system that meets all the bureaucratic requirements is small, because doing so is arduous and expensive and disheartening. So the few that exist don't have a lot of competition and people still use their product even if it's miserable. People not using their product would have been their incentive to make it better to use, and the disincentive that making it better costs money is still there, so they don't.
>But we think of this as a system for us and it’s not,” he said. “It is for the patients.”
Is wrong. It's a misnomer to call them medical record systems. They are primarily billing systems. Sure, improving patient care or reducing paper records are nice. But the #1 thing is to document the care to allow them to bill insurance or the government.