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.

Ever since I first saw Fred Trotter’s post about CONNECT being the future of EMR interoperability, I was really interested in the open source software CONNECT. Of course, when the PR person from ONC emailed me with an opportunity to talk with someone from ONC, I jumped at the chance.

The following is a short video where I tried to capture what ONC is doing with NHIN and CONNECT so that people can be more informed on these 2 projects. I hope you enjoy:

This video coverage of HIMSS 10 sponsored by Practice Fusion and their Free EMR.

I got an email asking me about converting an EMR from one EMR vendor to another. No doubt as time progresses, we’re going to see more and more clinics having to make the switch as clinics continue to consolidate. Here’s my response to this person. Hopefully other people will find it informative.

Converting an EMR is an incredibly challenging affair. Especially when you’re trying to convert from an ambulatory EMR to a hospital EMR.

There’s so many factors I’m not really sure where to start. I guess the first question is did you negotiate in your contract with Practice Partner that 1. you own the data in your EMR and 2. they would provide the “database schema” of the EMR so you would know where and how the data is stored in the database?

If you don’t have these 2 things, then converting the data is going to be an extremely big challenge. Even with these things, you can expect some major challenges. One EMR vendor described the conversion process the best. He described it as an imperfect science where you’ll never know 100% for sure that you got ALL of the data out and done correctly. You can know you’re close, but it’s almost impossible to know you got everything out of the previous EMR. It’s basically a best guess and often requires an iterative process where you think you got most of it and then you realize that something else is missing and so you have to go back and see what you did wrong.

The future of EMR is for the EMR interoperability standards to improve to a point where you can essentially “export” all the data from your EMR in some sort of standard format which you can then import into a new EMR. Those standards will be used by patients when they switch doctors. They’ll also be used by patients that want to have their own “PHR.” They’ll also be used by specialists to interact with primary care doctors. However, these standards have a long way to go. So, until then, it’s going to be an imperfect science.

Anyone else have thoughts and suggestions for those looking to convert from one EMR to a new EMR?

I like reading the weekly newsletters from XLEMR. Ryan Ricks has a way of making complex issues simple. This is a part of his recent newsletter.

Meaningful use has four main functional requirements: computerized order entry, drug interaction checking, maintaining an updated problem list, and generation of transmissible prescriptions. A certified EMR system must provide these functions, and physicians must use them daily for all their patients. In addition, a certified EMR must be capable of sharing information and working with other systems.

The HIT Committee wisely chose existing data standards for their recommendations. Health Level 7 (HL7) is data standard based on the Extensible Markup Language (XML). HL7 was developed for earlier government programs, such as the Doctors Office Quality Information Technology (DOQIT) and Physicians Quality Reporting Initiative (PQRI).

For the full newsletter, go to: http://www.xlemr.com/b2evolution/blogs/index.php

What are your thoughts on the direction that the HIT committee is going?

From an Interview with Bill Gates of Microsoft. Some of his views about electronic medical records and healthcare. See complete article.

Mr. Gates was also critical of the United States government’s unwillingness to adopt a national identity card, or allow some businesses, like health care, to centralize data-keeping on individuals. “It has always come back to the idea that ‘The computer knows too much about you,’ ” he said. The United States “got off to a bad start” when it comes to using computers to keep data about its citizens, he said. Doctors are not allowed to share records about an individual patient, and virtual doctor visits are banned, he said, which “wastes a lot of money.” The United States “had better come up with a better model” for health care, he said.

I agree and disagree with Mr. Gates. We need more data sharing and more interoperability BUT confidentiality IS an important issue. Just look at how the drug tests became public about Major League Baseball Players when they were PROMISED it would be strictly confidential!!!! I don’t trust big government or big business. Question: How do you tell an attorney or politician or corporate executive are lying? Answer: Their lips or moving or their fingers are typing!

We have to make sure medical information about individuals remains confidential and remains in the control of the individual.