As I mentioned in a previous post, almost every EHR vendor out there has some sort of mobile component to their offering. This tool is typically a useful extension of the EHR for every physician using the system, from primary care providers to specialists. Try to envision a car that will satisfy the needs of every person in America. It needs enough seats to fit a large family, and don't forget about good gas mileage and passenger comfort. If you're building a car for everybody, it would probably look like a minivan. Similarly, the mobile component to most large EHR systems is the minivan of mobile software. You sacrifice performance for the ability to do something for everybody.

Now imagine that you're a consultant for a large health system that just spent millions dollars and thousands of man hours implementing a cutting-edge EHR across all of their facilities and clinics. Sure it was expensive and took a few years, but since it's such a comprehensive offering the health system only has to work with a handful of vendors instead of a hundred. Your job as the consultant is to help them determine which vendors will comprise that handful. Some of the physicians have mentioned an app they currently use called "pMD," so you've started investigating the EHR's mobile offering. Doctors can use the EHR’s mobile software to look up patients’ clinical information and order medication refills without logging into a desktop environment. You start wondering what it can't do and schedule meetings with doctors to discuss your findings.

In your meeting, primary care physicians and specialists rejoice! The EHR's mobile app, as you would expect from a minivan, offers utility for nearly everybody. 70% of the doctors are satisfied and head home. But the specialists hang around and keep asking you questions. The cardiologist is wondering if it can work offline. The critical care doctor asks how quickly she can capture hospital charges for 30 patients on her iPhone. A hospitalist asks how fast he can take over his partner's patients and view handoff information in the app. What is this "pMD" thing they keep mentioning? Although these specialists only comprise about 20-30% of the physician headcount, you know they command a huge percentage of the health system's revenue.

So what's going on here? You just tried to replace somebody's race car with a minivan. The minivan can go farther and fit 8 people with all of their luggage. A race car can't do that, and frankly it's not all that comfortable to drive. But how fast is the minivan? What if somebody is extremely busy, and their primary need is to get from Point A to Point B, on a paved road, disgustingly fast? The number of passengers, luggage capacity, comfort, and all-around capabilities take a back seat to speed.

These specialists need the race car of charge capture because they are insanely busy. They usually spend half of the day seeing patients in their clinic and the other half driving around to around to various hospitals rounding on another 20-30 patients. They are up before the sun and still working on documentation at midnight. The math on an extra few seconds or clicks on a per patient basis adds up quickly. This is why they can't use a minivan for charge capture. If you give them the minivan, they will wait until they have time to use it: at the end of the week or at the end of the month. And where does this revenue reside between weekly or monthly submissions from the specialists? On paper.

A significant amount of the revenue these doctors generate, and therefore a significant percentage of the health system's revenue, is generated outside of their office clinic, so this can be hugely detrimental to the health system's business. At best, it slows down a large amount of revenue. Worst case, the paper (and revenue) goes missing entirely.

EHR mobile solutions and pMD Charge Capture are not mutually exclusive for the same reason that you might keep a minivan alongside your race car in the garage. The minivan is the clear choice for taking the family to a tee-ball game, but it would be absurd to show up in a minivan for some track time at the local raceway. The EHR's mobile solution is built with every physician in mind, and pMD is purpose built for specialists. Although a user may never be able to articulate why, they can definitely tell you that using pMD for charge capture is insanely fast. I can't fault them; I can't clearly explain the excitement of driving a race car with words, but I sure can tell you I love the feeling of such raw power and performance. What is it about pMD that doctors love so much? I've worked with doctors that use pMD all across the country and I'll do my best to articulate why on the next post. Cheers!

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