Monday, September 02, 2013

Why Indian doctors do not use EMRs

As an investor , I meet entrepreneurs who are designing clever solutions in the healthcare space . One of their commonest questions is – Why don’t Indian doctors use electronic medical records ? EMRs have now become standard in the US and one would logically think that if they have been shown to improve medical care in the US , then wouldn’t it make sense for Indian doctors to adopt them as well ? After all, doesn’t the fact that the US government is incentivizing US physicians by giving them over $30,000 to adopt EMRs prove that they are useful ? Why are Indian doctors so backward ? Why aren’t they willing to use EMRs when clever India entrepreneurs are willing to provide them with high-quality EMRs for fraction of the cost which US companies charge ?

Logically, it makes a lot of sense for doctors to use EMRs . Having all the medical details of their patients available on their fingertips, 24/7 can be  a major value add ! Does the refusal of Indian doctors to use EMRs mean they are stupid ?

Indian doctors are not stupid -  it’s the entrepreneurs who are being short-sighted . They expect Indian doctors to uncritically accept what is happening in the US, without appreciating the fact that the ground realities about medical practice in the two countries are completely different. Indian doctors would be stupid if they just blindly adopted a US solution.

Part of the problem is that most of these entrepreneurs are not doctors. They are IT specialists, who look for technological solutions to every problem, without understand how messy real life can be. While their solutions look great on paper, implementing them in a busy clinic where a doctor has to see 20 patients in 2 hours is just not practicable.

While US doctors are being forced to use EMRs, thanks to Obamacare, it’s only now that they are realizing how harmful EMRs can be. There are plenty of real-life horror stories of EMRs failures , but US doctors ( and their patients) are being forced to act as guinea pigs in this huge and expensive experiment which has been thrust down their throats. Most EMRs reduce the doctor’s productivity and while this may not matter much in a HMO setting, this can create havoc in a private practitioner’s clinic.

Indian doctors are extremely busy , because they usually see about 3-4 times as many patients as US doctors do in the same time. Most patients do not bother to take appointments; and walk-ins are very common. Patients are not punctual and will often fail to show up for appointments, without even bothering to cancel them.  Many are not literate ; and most cannot read or write English. Every doctor has to accept that the culture he lives in will have a huge impact on the way he practices – and what works well on paper; or in the US (where appointments are the norm) , will not work well in real life in India. Indian doctors cannot afford to disrupt their throughput. They are frugal and smart  and need to be sure that not only are EMRs cost effective, they also help them improve their productivity and efficiency. While EMRs work great during demos, implementing them in real life  can be a real headache. Most doctors don’t have secretaries and receptionists to do their data entry and they cannot afford to fill in the details themselves ! How can he use the EMR if the assistant is on leave that day ? Will the EMR work if the internet connection goes down ? How can the doctor be confident that the company will be able to continue to support the EMR and not go belly up ?

EMRs can disrupt a doctor’s workflow, and this has been proven many times over , whether we talk about free open-source EMRs , or the ones which cost hospitals billions of dollars to deploy. Many doctors just flatly refuse to use them , because they just cannot get them to work properly in their clinics. This does not means that doctors are Luddites – it just means that the EMRs are badly designed . This is why doctors are so cautious when they consider using EMRs. While computers can break down and internet connections are not always reliable, pen and paper is always available and very flexible and easy to use !

If entrepreneurs came with solutions which would help doctors to improve their productivity , I am sure doctors would adopt them. After all, doctors are rational, and will respond to the right incentives !  This is great opportunity because this is a completely untapped market in India so far. At the right price point, lots of doctors would be happy to utilize electronic medical records so that they can take better care of their patients . Doctors understand the value of documentation and realize that having it available in an electronic format would make life much easier for them. However, most EMRs available today are just modified versions of the ones available in the West – they are pretty mindless copies.

Doctors all have their own individual quirks and each practice is different. One size cannot fit all and doctors need an EMR which is flexible so that they can customise and tweak it to fit their needs, without having to ask the IT guy to do this for them. A smart entrepreneur will design an EMR platform, which doctors will be able to modify to suit their needs, so their workflow is not hampered and their productivity is not disrupted.  Generic templates could then be created for each specialty by interested doctors; and other doctors could use these, or modify them if they wanted to do so .

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