Editorial Comment:
Medical Information Systems Hot Topic: 12/5/01
ASP
As a physician, I wouldn't deal with an ASP because of it's inability to come closest to the 100% efficiency I need. When looking for solutions, I need something that comes as close as possible to 100%, otherwise you upset my rhythm, which translates down line to my staff and patients. I find it much more efficient for the times when technology fails, and it will, to have my applications nearby, with my own server, on my own network. Sure the resulting data can be manipulated and sent here and there after the fact, put the actual use of an application such as an EMR needs to provide end-users with the highest degree of efficiency. So it isn't so much how well a system works, as it is what it does to my work rhythm when it isn't operating 100% efficiently. Now from a vendors standpoint, one might find that requirement of mine a bit unreasonable. However, I only hold others to the same standards the public holds me. And I am an early adopter of technology, so my tolerance for snags in technology is greater than the typical end-user. In fact I actually find technology snags something of an invited diversion that helps to stimulate my mind. However, I doubt the majority of end-users would say the same. Thus, the difficulty getting droves of medical professionals to adopt technology for the documentation portion of their job. Solutions providers face an added difficulty in the fact that they are blamed for all snags that occur in a information system, whether it is the software or the hardware. I am sure many software developers would agree. Hardware problems arise, but it is almost always blamed on them. From that standpoint, and from an end-users perspective, I don't want to be talking to some tech guy 3 states away when my system is failing me. Who knows where the problem exists in the system. Therefore I find it more comforting if I can eliminate as many of the variables as possible, including having the ability to contact my own hardware repair person, touch my own server, and watch my own on-off switch, rather that wonder if the guy on the phone can do-it or if he is just answering phones for the level 2 tech. Because, the rhythm disturbance that just occurred with me trying to get the ASP problems fixed caused 2 patients to walk out aggravated......and they just told 17 other people about their aggravation. As an early adopter, and someone that has used an EMR for 6 years, I would say that the software company that has come closest to receiving the most public tolerance for times when their products snag, is Microsoft. Yes they have the OS market somewhat cornered, but they also have developed stable products. I believe if any company is going to be given the end-user's patience for the inherent snags in an ASP solution it would be Microsoft, and they are going to have a tough hill to climb. And even if they develop a system, they will then have to deal with those that feel they have too much control. So, is the ASP environment going to experience exponential growth in the next few years? I believe it will with only 2 segments of end-users; 1) early adopters which make up perhaps 15%, 2) Those that are mandated to use the system, which is a lower percentage unless medicine all of a sudden becomes socialized.
What vendors aren't realizing is that as the technology age progresses, the end-users naturally become more knowledgeable. When this occurs, they then develop the ability to perceive the inherent weakness in a system, rather that standing in front of a monitor like a "deer in headlights". As this savvy end-user evolves the distrust will peak, and once again the need to eliminate the variables that disrupt the rhythms necessary to operate a medical practice efficiently. There will come a time in the near future when all the hoopla that technology sales and marketing divisions bombard medical professionals with will be recognized as such. Much as the "Art of Medicine" has been tainted by too many business entities jockeying for positions, so too are the efforts of those trying to bring information technology to medical professionals. In the rush to give us the "Holy Grail", they have overlooked the value of a solution that is pure and simple. Pure and simple is what will prevail with the mass of end-users yet to jump on the band wagon.
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