FierceHealthIT editor Ken Terry had a recent post on the need for better human-computer interfaces in EMRs. He highlighted a few areas where EMRs could stand some improvement, and I thought they were bang on. These are aspects I’ve thought about a great deal myself, and true to the Steve Jobs dictum of staying foolish, I’m offering some solutions to these oft-mentioned problems. I’m sure there are plenty of people who have already thought of these and better solutions, but here we go:
1) Initial Data Entry – The biggest headache for providers’ offices today is what to do with all those boxes of medical records. Scanning solutions exist but they leave you with unstructured data. Manual extraction is time-consuming and requires upfront investment. I’ve pondered for a while about this. I think on-demand data extraction might be the way to go. Provider offices know ahead of time what their weekly, even monthly appointments are. If a provider’s office digitizes the records of patients with upcoming appointments every week, it should have most of its records digitized by end of year. This is assuming patients make it to the doctor’s office for at least once-a-year appointments if not more. If the office outsources this work, it needs some monetary investment, no doubt, but such a setup might be affordable since it is pay-as-you-go.
2) Templating – Terry states that many doctors hate the templates that come with most EMRs. And templates make it easy to generate pages and pages of verbiage which say exactly the same thing for patients with similar profiles, or say very little that is meaningful. Surely customizable or extensible templates can get rid of this problem. Or speech-to-text dictation that allows the doctor to mirror practices from not so long ago.
3) Alert Overload – Many EMRs are designed to issue alerts for adverse drug interactions, prompts for patients and similar such decision support tools. But too few of these and you risk not asking the right questions. Too many providers just ignore them, or worse, override them. No easy solutions for this one, except maybe to figure out where the fine line lies between lack of decision support and too many alerts.
4) Interoperability – EMRs cannot talk to each other. So a patient who moves from one provider to another is really at the mercy of software whimsies. Or worse. For providers, it’s equally frustrating not to be able to get ahold of the patient records in a format suitable for their particular EMR software. One simple answer – standards. Granted HL7 is still evolving, but EMR vendors need to at least consider offering data exports in this format.
Initial Entry. I agree about converting records as patients come in.
I recommend treating any patient who has not been seen in three or more years as a new patient. The old record should be reviewed and scanned in where needed and then retired.
I recognize, however, that different consultants have different styles. What counts is a system that’s understandable, responsible and gets the practice up.
John, as always your timing is perfect……………
We are participating in a pilot with ONC on the interoperability, Transition of Care (ToC), etc., from one EHR to another and from EHR to any PHR using some of the new standards including CIM and other valid standards that are being created. Its interesting and as an optimist, we have a long way from the ‘CAVEMAN’ days in healthcare and surely we’ll get there to interoperability sooner than later.
On another note, you must have seen this already…….
Pledge To Empower Individuals To Be Partners In Their Health Through Health IT
The U.S. Department of Health & Human Services’ Office of the National Coordinator for Health Information Technology (ONC) is leading a national campaign to educate and engage the public on the value and benefits of health information technology (health IT) in improving health and health care. As part of the campaign, we encourage entities that touch Americans’ lives to pledge to empower individuals to be partners in their health through health IT. Taking the pledge is voluntary and does not represent any endorsement by the U.S. Department of Health and Human Services or any other part of the Federal government.
EHR will gain traction in adoption more so through the consumer demand going into the future. At least that’s what we believe.
I agree that the consumers driving EHR adoption could be one way to achieve widespread EHR adoption. The other powerful force will be the set of new doctors who love technology. We’ll see how it plays out.
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