Via #Payer + #HCP: Imagine a physician-designed EMR – The title itself should make us all cringe! If there's one t… http://t.co/1Gz3wSPjG5
— Mandi Bishop (@MandiBPro) March 16, 2014
I really hate this discussion. It reminds me of the republican-democrat debates. They always go too far and both sides (in this case Physicians and EHR vendors) often only see their side and miss the opposite viewpoint. It’s very polarizing. The best situation is the mix of both sides of the equation. Plus, you usually need someone who can help translate and moderate between the two viewpoints. That’s much easier said than done. You can definitely learn a lot about an EHR vendor when you learn if they’re more physician designed or tech designed.
#EMR & #HIE Vendors: Stop sending me to @ONC_HealthIT SIF Wiki in lieu of documentation on YOUR implementation of the CDA standards.
— Mandi Bishop (@MandiBPro) March 13, 2014
Many people unfamiliar with these standards probably don’t undstand this tweet from Mandi since they assume it’s a standard and so the ONC documentation should be good enough, no? The reality is that every implementation of the ONC standard is different and you have to have documentation of how that EHR vendor implemented the standard.
Is this some kind of a game? I should start my own rating site! http://t.co/JWAbEBtp5U #emr #ehr
— Chandresh J Shah (@chandresh27) March 11, 2014
I appreciate Chandresh’s tweet more than most. I’ve often considered the idea of starting an EHR rating site. They are a dime a dozen and I don’t think any of them are very good. The best ones use some high level filters to help you narrow the search. This has some value, but isn’t really an EHR rating site. The problem with an EHR rating is the sheer scale of responses that you need to collect for it to be valuable. There are 300+ EHR vendors. There are 40+ specialties. There are practices from solo doctor up to hundreds in a multi specialty clinic. There are 50 states. There are hundreds of insurance plans. You get the picture. The number of randomly collected quality ratings you would need is impossible. I enjoy a good list as much as the next person, but just remember what I mention above when you see the next list of Top EHR vendors.
Then again. Maybe Chandresh and I should get together and do an EHR rating service based on if the EHR was a physician designed or tech designed EHR.
Chandresh, I would agree wholeheartedly. EHRs designed by doctors DO exist, and it is obvious when demonstrated, as the physician has that “aha” moment when they realize the workflow makes sense to them. You see, the doctor’s frustration is usually within the note, and the little tiny aspects – such as where to click, and how many times – that make repetitive work become a chore, rather than just a natural part of the process.
I would LOVE to see a new, in depth type of EHR review system, where these labor intensive tasks are ranked, especially when you have companies like ours who are totally devoted to designing WITH the doctors, not for them. Our EHR team spend 2 1/2 years inside a multi-doc practice and surg center designing the EHR’s workflow by watching how the physicians work, getting their input, changing the program (in one case, rewriting most of the code to eliminate one unneeded click in a process at the request of a doctor), and then testing, testing, testing across multiple specialties.
The doctors we worked with in designing the system are now our beta test sites, and no update or revision is included that hasn’t been requested and/or tested by the people who use the system. This story runs very deep for us, as we built our entire company and product on the notion that doctors are smart, and they know what they need.
As a result of including them throughout the design and testing, they are able to chart and work better, and much of the burden imposed by EHRs in general have been eased such as is possible to do so. I urge more doctors to ask questions of their vendors such as, what is the phone number of the doctors who helped design your workflow?
As Dr. Jeffrey Ginsberg noted after looking at 15-20 EHRs, “it was obvious doctors were involved in designing this,” You’ll know the right EHR when it works the way a doctor actually works. They do exist.
Michelle,
One problem with only working with one or two doctors is that it still depends on how good the doctor you start with is at articulating what’s needed across the whole spectrum of providers, specialties, etc. Do they only know how their practice works or can they really articulate the breadth of requirements that the 700k+ doctors need?
Anyone can create a great system that works for a specific clinic’s needs, but can they develop one that is flexible enough for everyone or even for everyone in a specific specialty?
Good point John. We worked with about 15 physicians, and about 40 staff, from OMs to MAs and billers. You are right, you can’t get everyone’s specifics worked out, but we had enough of a base (and continue to use these folks to beta test new features on a regular basis). Our latest release had input from about 20 doctors. It’s just a philosophy that we work by.
Michelle, your point – conceptually – is well taken. Taking providers’ input versus them dictating the design is where it becomes messy. EMR / EHR are no longer EMR/EHR systems. They are a lot more.
They have evolved into true Medical Practice Business systems. Like ERP for Manufacturing systems.
They now help manage the entire business of a medical practice – even sometimes marketing to patients.
One Place where providers’ input is essential is point-of-care data capture because this is where you have a breakdown in productivity and serious EMR usage complaints.
For the rest, I think bringing in doctors actually may be a detriment to good workflow and efficiency design.
But coming back to the original point, John, a good rating system is due.