Reading discussions of electronic health records is much like reading the fable of the blind men and the elephant: all were right, yet all were wrong. We in healthcare are staging a repeat of the introduction of business process re-engineering in the 1980s noted in the article, The Productivity Paradox, by Erik Brynjolfsson. The current information technology debate highlights this paradox in falling prey to what Lynne Markus and Robert Benjamin called the myth of The Magic Bullet Theory in IT-enabled Transformation, (MIT, Sloan Manamagement. Review, Jan.15, 1997).
In summary, IT is but part of a process normally involving a lag before realizing productivity increases. We would do better to think of information systems that include IT, organizational culture, training and retasking. My own group of six physicians installed an EHR system over eight years ago, and productivity gradually improved. Yes, workflow changes were requiredsome minor, some more sweeping, but we used minimally invasive processes that involved people at all levels in staging changes. One would hope our healthcare industry will not suffer relearning the lessons of what are IT and information systems.
William Cast, M.D.Chairman and board memberMedical Informatics EngineeringFort Wayne, Ind.
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