John Halamka asks what will it take for EHR to have a Visicalc moment. I'll answer based on three more examples:
- The IBM Selectric
- The HP 35 calculator
- The HP business calculator (a flop)
The first two were explosive successes that predate Visicalc and the personal computer. They were at least as big as Visicalc. The Selectric eliminated key jams, messy ribbons, manual carraige return, and added the correction tape. The HP 35 removed the problem of doing scientific calculations with adding machine and slide rule. But the HP business calculator was a flop. A marketing executive at HP explained why, and his explanation holds true for Visicalc and other would be successes.
The big winners win because the potential user instantly recognizes the product as a solution to a personal problem. The business calculator flopped because potential buyers didn't see the problem. What was wrong with using printed interest rate payment tables? Occasionally a buyer would be in a negotiation with someone who had a caclulator. The differential advantage the caclulator gave of immediately knowing the implications of changes to terms made the value apparent. But these were uncommon. Buyers were rare. The HP executive analogized to the hoof-operated fence cutter. It's a spectacularly important product to beef cows. But cows don't grasp the problem or see this as a solution. So it will never succeed as a product.
For the EHR the win will be when the users (physicians, nurses, etc.) must see the EHR as a solution to a problem. It's fairly easy to talk with them and learn what is it about their job that they love. You quickly find things that are described as "this is why I love my work". Make sure that the EHR does not interfere with these. Equally easy is finding parts of their job that they hate. These are usually the wasted time, screwed up schedules, missing information, time wasting data entry, and stupid endless form filling.
If the EHR genuinely eliminates the parts of the job that they hate, it will be a winner.
I have seen this effect in radiology with PACS equipment. One example is the transition to CR from plain film. Nurses and techs hated the darkroom, developer, and chemicals. They hated the problems getting exposure right. They hated the delays carrying films around. The CR eliminated these and were immediately popular. A very recent one is the use of DICOM for retinopathy screening. It enables doctors to grab the next study and read it when a scheduled exam is slightly delayed. They hate sitting around for 5-10 minutes doing nothing. It's not very long, but it's enough time to read one study. The PACS workstation let them grab the next study, read it, and report it during delays. Not only were the doctors happy, but they found that screening throughput increased 20% without changing the hours on the job. The administrators were very happy.