Reader mail: Pitfalls of EMR implementation

By THCB Staff

This recent comment about information technology implementation by a reader named Rob was so excellent it deserved re-running.

I'm a technologist. I've been implementing information technology professionally for 25 years. I've been doing EMRs for the last five. There are lots of ways this can go wrong, large or small.

1) Resistance: People hate change. Sometimes they're correct. Most often they're a self-fulfilling prophesy as, without technologists having support from above, and engaged knowledge from below, we end up the scapegoat. You can't computerize people. You can only make computers part of their job. Just as you can't make people fit a paper form.

2) Hyper-acceptance: Problem-solving people with good intent come up with brilliant ideas that ignore the basic nature of technology. Even if you include all stakeholders, unless they trust a professional technology staff, if they ignore good advice, if they simply order technologists to do as they say, it won't work. Information Technology is really People Psychology, and the best of us know something about both.

3) Technological Eeyores: A large percentage of technology professionals are about the machine. They're about the what and the how. They're not about the who. It's easy to fall into the view that the system was working perfectly before people got to it. Technology is 90% people. What are they doing? What is the real need? Can we do this without adding a gadget? These are hard questions to ask, and the broken and cynical among us won't ask them. Sometimes they're right that no one will listen anyway.

It is said that technology is an artifact of all the compromises the designers made to create it. I disagree. At its best, it is a living thing that's part of what people do; it's an aspect of its users. It can't tell us what to do, though. Nor can it ask. This can all go right, though. It can be successful.

That takes people. They're expensive. That's another thing. Can I, in all candor, ask that we, as a society, stop seeking cheapness and start seeking shared excellence? To me, that's the real issue.