Tuesday, December 6, 2011

Frictionless sharing does not work in EHRs

Mark Zuckerberg when introducing the latest updates for Facebook popularized the term frictionless sharing.  What it means is the user does not have to do anything specific to share something with friends on Facebook.  Thus if you are listening to some music on Spotify, your friends could see what you are listening to without your having to do anything.  You could opt out of this, but by default you are opted-in!

This is actually not a new concept.  Primary care providers have been exposed to this in the EHR for a while.  

Examples:
  • One fine day, out of the blue, you get some results for liver function tests in your EHR inbox.  The test results are normal.  This is a young adult patient for whom you are listed as the PCP but you have not seen in several years.  You try to find out who ordered the tests and why the results were sent to you. After multiple clicks and 10 minutes of searching you find out that the person had a positive TB test and a normal Chest X-ray and was going to get started on Isoniazid (INH) by an infectious disease specialist.  The specialist thought she was doing the patient and me a courtesy by sharing this result with me.  I want to know what's going on with my patients but I think this process was too well lubricated.  We need some friction.  I want the specialist to put a short message to tell me the what and the why and just summarize that the liver tests were normal.  
  • Another day you start getting a stream of lab results for one of your patients.  Some of them are quite abnormal.  You drop everything to attend to these.  You find out that the patient is admitted to the hospital and the results are being copied to you as a courtesy.  Great, I get to learn that my patient is hospitalized and what is going on.  Problem is it was not urgent, he was already being attended to and all I needed to know was a summary of reason of admission and who the attending physician was in the hospital so I could contact him/her to discuss.
Doctors realized quite quickly that frictionless sharing in EHR is not efficient and while useful, it could be done in a much better way.  Automatic sharing increase noise/signal ratio and in an EHR world where doctors are swamped with copied charts, patient messages, refill requests and test results, it just does not work. I am sure we will realize that this holds true for the social media world too!  Actually we are being warned already!