Moving away from functional and non-functional requirements of a system is probably the top priority in health informatics at this moment. “Ask not what the system can do for you, but what you can do with the system” seems an appropriate statement in these times of change.
Over the last few weeks I have been engaging heavily in discussions with clinicians, health IT managers and managers of healthcare provider organizations. The topic was invariably on the Electronic Health Record (EHR), be it a regional health information exchange or a local EHR system for one institution. A common theme in these discussions is the necessity to take the perspective of benefits to the individual healthcare professional, to the patient and to the health system at large. Participants often feel they need to express their requirements of an EHR system in terms of functionality, security and performance, rather than focussing on the ways in which their daily lives can be improved using such a system.

Of course, being able to access and organize patient information, to grant or restrict access to this information, to be able to rely on the system and ease of use in navigating the waves of data are prerequisites to the adoption of an EHR. However, they are not the triggers that will get people moving and enthusiastic about the implementation of an EHR. Moving away from these discussions, we have tried to envision the changes in healthcare delivery on a personal scale: what will you do differently when we deliver such a system? Trying to link to current problems and obstacles, pointing out almost forgotten but undesirable traits of the current operations (“that’s just the way we do things”) can provide valuable insights. Often this leads to more concrete and attainable goals than “all information available everywhere to anybody who is authorized to access that information”. Moreover, the specificity of what the system will mean to the individual also inspires clinicians into taking a leading role in the adoption process.
One such example comes from a colleague who has been involved with an EHR for children’s health. In the Netherlands we have a group of doctors visiting schools regularly to check up on all children there. They are used to carrying heavy cases of children’s health records. Now that they are being equipped with a laptop and wireless 3G internet access, they don’t have to struggle with the heavy load and don’t have to worry about taking the right set of records anymore. Simple, effective and quite motivating.
Such benefits are a far cry from what is being constructed in business cases for getting approval for EHR projects, but they are equally (or even more) important in the adoption process and hence for the success of the EHR project. We are starting an inventory of simple individual motivators for change using an EHR solution. I am inviting you, especially if you are a doctor or a nurse, to contribute your daily benefits and the changes the EHR system has made in your working practices.