The strength of a network is dependent on how active its members are. The network effect; greater value is gained when more people use it or when the existing members use it more often. The same rings true for Electronic Medical Records (EMRs), the more activity, the more valuable the system.
In the case of both social networks and medical records, one system will ultimately be more preferred than another – Rational Choice Theory explains this. What makes one system better than another? The tendency is that people will choose that which gives them the greater value. For social networking, being able to easily create a personal site and to easily connect that to other people offered greater value in comparison to the relative harder task of creating a traditional personal website and then trying to connect that with other personal web sites. There is an element of behavioural economics involved. For Medical Records, being able to easily document and recall the clinical engagement, is preferred over systems that take too long or are difficult to learn or use.
Why did MySpace, the early leader in social networking, ultimately lose out to Facebook? Why is one Medical Record system generally more preferred to another? In the case of Facebook vs MySpace, there is an argument that Facebook allowed the market to dictate to it, and that Facebook adapted to the market needs; user adoption followed naturally. With MySpace, the management attempted to dictate to the market, trying to get users to adapt their social networking to those methods that MySpace promoted, resulting in less users adopting the platform. www.forbes.com/sites/adamhartung/2011/01/14/why-facebook-beat-myspace/
Paper vs Electronic Medical Records have a similar tale. Many EMRs are prescriptive in nature, are hard to learn and are often difficult to use; in contrast to paper medical records. The rational choice therefore leads many users to revert to paper. The associated behavioural economics and network effect means remaining users need to follow the herd.
There is a vicious circle when implementing an EMR where behavioural economics are at play. So often an EMR is procured not by the end-users, but rather by a separate function. So often a chosen EMR is prescriptive in nature (similar to the MySpace philosophy). In order to adopt the system, the end-users must adapt to the dictated paradigm. However this presents a barrier, and where there is an option to stay with or revert to a paper medical record, end-users take that choice. The network effect propagates that outcome, resulting in a reduced or negative ROI. Then, those that have procured the system, invest more time and resources, in the belief that, with training, etc, users will adapt their clinical practices and adopt the paradigm. So often this results in less and less adoption, resulting in even less of a return, and so on. After some years of these cycles, a hybrid medical record remains. Then a procurement process for a new prescriptive EMR is initiated. The failed strategy is repeated. Often with fresh blood. So often.
Billy's previous entries in his series can be accessed below:
www.slaintehealthcare.com/Insights-Information/Insights/ArtMID/6323/ArticleID/200/The-Road-to-a-Virtuous-EMR-Episode-VI
Billy Diggin - Chief Technical Officer
Billy joined Sláinte Healthcare in 2009 as Chief Operating Officer, where he has responsibility for day-to-day technical operations, new product development, and commercial assessment of new products and markets. Billy now holds the position of CTO, bringing over 20 years of experience in product and business development in electronics manufacturing and software automation. Billy was VP Engineering and VP Business Development for Xsil, Director of Software, Pentus Technologies. He has a Bachelor’s and Masters Degrees in Engineering from the University of Limerick, and a first class honours MBA from Smurfit Business School, UCD.