EHRs and Cars: Don’t Let Perception Cloud Purpose

Cars and EHRs are both pieces of machinery but they are also many others things, at least in the eyes of the beholders. They can be signs of affluence, sources of prestige, expressions of personality, etc. Just as each individual has a mental image of themselves that may bear no relation to any of their observable physical and personality characteristics, each prospective owner of a product has a mental image of what they plan to buy (if you will allow an anthropomorphic reference to an organization) and how they will relate to it.

The selection of a product is strongly, perhaps totally, influenced by these mental images and how the purchaser believes that the selected product will correspond to or complement their vision of what it will be like to be the proud owner of whatever it is, be it widget, car, or EHR.

Nothing in this formulation requires that the customer's idealized vision have any relationship to the actual design or performance of the mechanism that is within the product. Indeed they may not even appreciate that there is a mechanism.

In an old story about a tribal potentate in a desert country before oil had been discovered in the region, the king receives a Rolls Royce as a gift. He was proud to be seen in public, sitting majestically in his car as it was pulled by a team of horses - there being no fuel. The display and attendant prestige was all important, the mechanism was irrelevant.

For a race-car driver, the design and performance of the mechanism is critical. Speed is required to win, as is being able to maintain control throughout the race. For someone with cargo to transport, the shape and size may be the most important as long as the engine and brakes are adequate. For many people, prestige and style are critical.

Two scenarios can cause the greatest disillusionment. The first is when a selection is made using criteria that have no direct relationship to the use to which the product will actually be put, such as choosing a family vehicle because it is a "cute" two-seat convertible and then having triplets. The second is when, as the new owner gains experience and realizes the importance, they become aware that they have not gotten the performance that they need.

As it is with cars, so it is with EHR. The basic purpose of an electronic health record is to capture and preserve patient medical records and to make the information contained therein available as data that can be used to affect patient care and enable effective coordination of that care. The selection process rarely focuses with laser-like precision on this goal. Many other criteria seem to be important and an organization's vision of all the great things that a new EHR will do for them often becomes the primary object of the decision-making process.

The primary result of losing track of the primary reason for having an EHR leads the deciders to minimize the attention that is paid to the mechanism inside the EHR that makes it run. I know that my car has an engine but I never think about it but I also know from years of experience that the job that I expect the car to do is within its capabilities under most circumstances.

Several things are essential to choosing the right EHR: clarity about the primary job of EHR, understanding the job each candidate is actually designed to do, and a sober assessment of why you really want one. In the absence of experience with a particular EHR or technical understanding of how its "engine" works, it is not possible to have reasonable certainty that a product's capabilities match your actual, not your imagined, needs. There is no magic in the mechanism. Neither an EHR nor a car will do anything its mechanism does not make possible and wishing or expecting otherwise will not make it so.

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