HIMSS 2018 and EMR Atheism

Today is the first day of HIMSS 2018, a conference being held in Las Vegas in an exposition center in which the cheapest 10’ x 10’ booth costs $3,600 plus a $400 “booth listing fee” and attended by a number of people who speak frequently of the waste that is in healthcare. In the next four days, thousands of people will state that their technology is “EMR-agnostic”.

The first thing that comes to mind when I hear someone use the phrase “EMR-agnostic” is that they must not be very religious. According to Merriam-Webster, the definition of “agnostic” is:

  1. a person who holds the view that any ultimate reality (such as God) is unknown and probably unknowable;  broadly : one who is not committed to believing in either the existence or the nonexistence of God or a god; or 
  2. a person who is unwilling to commit to an opinion about something.  
In my experience, almost everyone who attends HIMSS is quite the opposite. Not only do they believe in EMRs, they are quite zealous in their belief. What they mean to say, or at least convince you they believe, is that they are EMR-neutral or perhaps EMR-impartial. Anyone who is truly EMR-agnostic is simply not paying attention. Anyone who is paying attention knows why politicians are not EMR atheists.

Unlike almost everyone at HIMSS, I am an EMR atheist – I don’t believe in EMRs, and I never have. If 30% of spending in healthcare is actually wasteful, EMRs are largely to blame. Why? Because EMRs are not electronic medical records; they are simply billing systems. Only in healthcare does a system that is very specifically designed for one purpose masquerade as something else. Only in healthcare does a function like generating a bill get harder instead of easier over time. And no other industry is as beholden to its vendors as health systems are to EMR vendors.

Less than ten years ago, I could pay for a taxi with cash, or by letting the taxi driver swipe my card with the NBS Manual Credit Card Copy Machine Swiper Flatbed Imprinter Carbon Merchant. Today, my credit card is linked to my Uber account, or the taxi driver plugs a Square credit card reader into his phone, swipes my card, and sends me an electronic receipt before my feet hit the pavement.

What has healthcare done in the past ten years? Take a technology that was poorly designed for its essential purpose, i.e. generating a bill, and attempt to convert it into something completely different, i.e. a clinical decision support system. Lipstick on a pig is just that.

In a world of mobile payments, price transparency, telehealth, personalized medicine and soaring patient deductibles, something other than an EMR will become the system of record for healthcare transactions. When that day comes, all of us will benefit from more choice, knowledge and control over the most personal part of our lives.