June 2016

EHRs and French Philosophy
By Lee DeOrio
For The Record
Vol. 28 No. 6 P. 3

When it comes to the usefulness of EHRs, the health care industry is not lacking for opinions. Everyone from government officials and C-suite leaders to HIM professionals and patients have strong thoughts on whether electronic records are worth the fuss.

Whether the industry likes to admit it or not, the collision between reimbursement, quality care, and physician satisfaction can make for uneasy conversations on what constitutes the ideal EHR design. Then there's the matter of implementation—the associated costs, the workflow changes, the training. It's a nerve-wracking process filled with doubt.

But perhaps the industry's approach is all wrong. What if leaders took a page out of French philosopher Jean-Pierre Dupuy's book and practiced "enlightened doomsaying"? According to the theory, it's necessary to imagine ourselves in the unthinkable future, staring straight down into the black hole of nonexistence. Sounds discomforting, but "To believe in fate is to prevent it from happening," Dupuy wrote. Applying that philosophy to EHR implementations just may be the dose of pragmatism necessary to curtail both complaints and grandiose expectations.

I'm struck by two thoughts Dupuy expressed in a journal article titled "Enlightened Doomsaying and the Concern for the Future." Here's the first:

"Our responsibility is all the more enormous as we are the sole cause of what will happen to us. And yet there is a danger that our sense of our own responsibility will increase, rather than diminish, the very arrogance that gave rise to it. Once we have persuaded ourselves that the salvation of the world is in our hands, there is a risk we will throw ourselves with renewed energy into a headlong rush toward the abyss—that fatal impulse compounded of pride and panic, which with every passing day comes nearer to being the outstanding emblems of our age."

To me, that combination of pride and panic seems to have descended upon the health care industry, enamored with technology but afraid it's careening out of control, taking over processes in such a manner that no one likes using the darn thing.

Dupuy's tempered outlook is more reassuring, a reminder that while doom can be viewed as inevitable, it also can be a catalyst for improvement.

"When one announces that a catastrophe is imminent, in order to avert it, this announcement does not possess the status of a prediction, in the strict sense of the term: one does not claim to say what the future will be, only what it would have been had preventive measures not been taken."

Granted, these are esoteric concepts that most health care professionals won't be thinking about when they're forced to scroll through multiple screens to obtain the patient information they need. Nevertheless, the next time you're in discussion about how to move your organization forward, it may be helpful to mind Monsieur Dupuy's ruminations.

edit@gvpub.com