Years ago I read the cannon of the classic medical book “House of God” by Samuel Shem which reads: “…the House of God was sad and sick and cynical…like all our doings in the House…” At first, before I had worked in an actual hospital I thought the book itself was sick and cynical. After working in an actual hospital I re-read the book. I then found it hilarious for its uncomfortable truths, and did not think it was sick or cynical enough. Therein likes the crux of the matter with regard to very expensive large hospital EHR’s.

I’ve wondered for years why large hospital EHR deployments are reported to cost north of 100 million dollars. I’ve asked the question what is that software made of, Unicorn dust? I’ve also heard reports that the EHR company in question fields ‘an army’ of workers for its go-live. I’ve wondered what justifies all this and what justifies the giant budgets. In working in and around hospitals for 20 years now I’ve come to some conclusions.

As the House of God points out, the human tendency towards dysfunction, sabotage, infighting and more is alive and well. It is often exhibited in raw relief in hospitals from the lowest employee to the highest management. My theory is that’s precisely why these systems cost so much and why you have to field, maintain, and deploy an army of go-live personnel to do it.

The army is there to absorb and contain the dysfunction and tendency towards sabotage at all levels that can occur with a technology deployment. Most people resist change but they are more likely to change when the EHR stranger from afar representative is standing in their midst to be therapist through the change. People are also much less likely to sabotage, poison others, and lapse back into dysfunction with the stranger from afar representative standing right there.

Thus the hundred million dollar price tag. It isn’t the price of the hardware or software. It is the price of the change, absorption and redirection of dysfunctional tendencies while preventing sabotage.<

Open and important questions: How do you know you are not replacing one dysfunction with another? Will the new dysfunction be revealed only with time? Possibly a long time like years to decades? Who is watching the watchers, training the trainers and on what basis? Are we creating hydraulic empires and oligarchies with these proprietary systems being put in place? How long before they become the problem and not the solution?

Author: Ignacio H. Valdes, MD, MS has been thinking about and implementing EHR’s since 1985. He is managing member of Astronaut, LLC http://astronautvista.com Electronic Health Record which offers a VA compatible VistA variant for the private sector.