Welcome to EMR and EHR

I always like it when people ask me questions about EMR. That way, I know that I’ll be providing at least some value to someone. Brian asked the following question in the comments:
Do you know who actually makes the decisions to purchase EMRs? For example, at large hospitals or medical groups, is it CIOs, and in small practices is it physicians?

This is a really hard question to answer. In fact, it’s likely one of the reasons why making the EMR sale is pretty hard. Each organization is very different. I guess this is a byproduct of the capitalist society that we live in.

That said, in hospitals, it usually is the CIO that is making the final decision to purchase an EMR after the CEO’s approval of course. Although, many times the work of selecting the EMR software and going through the EMR review process is delegated to a committee of people in the hospital organization.

The medical groups are harder to analyze since they come in all shapes and sizes. Not to mention varying governance structures. I would likely define these practices in two categories: physician run groups and manager run groups. You can guess who makes the decisions in these two categories. With that said, the doctors can really make an EMR implementation miserable if they’re not on board with the EMR selection. So, even if the practice is not physician run, you better consider these doctors in the process.

Small groups are generally more heavily influenced by the physician’s choices. Occasionally you’ll come across a strong practice manager, but usually that person is strong because they know how to work well with the doctor and their needs.

Certainly there a lot of other variations, but this is generally what I’ve seen.

Neil Versel wrote an interesting piece over on Fierce Mobile healthcare which talks about EMTs and hospitals using technology to facilitate better care for patients. Neil however argues (rightly so) that not many emergency physicians are going to make a diagnosis based on a grainy photo. Then, he goes on to talk about video. Here’s a small section of his article:

Now, imagine if doctors and nurses could provide real medical advice to help EMTs treat patients in transit based on high-quality, two-way live video. That’s exactly what they have been doing in Tucson, AZ, for nearly two years, thanks to a 227-square-mile Wi-Fi grid that covers most of the city. East Baton Rouge Parish, LA, which includes the city of Baton Rouge, recently launched a similar system that eventually will link to seven hospitals across the parish.

Tucson’s University Medical Center saves $5,000 each time it can prevent an unnecessary activation of a Level 1 trauma team and, more importantly, can save lives by providing remote diagnoses and triage and making sure the trauma team is ready while the patient is still in transit. I wrote about this technology in the May issue of Hospitals and Health Networks, but that short piece only tells part of the story.

I just love the fact that hospitals are looking at this. However, I couldn’t help but have my mind drift off into an EMR. I wonder if this same video technology won’t one day be introduced into an EMR. Only makes sense to me. Hard drives are getting bigger. Video technology is getting smaller. One day a doctor won’t need to chart at all. They’ll just have the full video.

Now we just have to ask ourselves if that’s a good or a bad thing for doctors.

UPDATE: I started thinking and seemed to remember having a similar idea before. I thought it was with recorded audio. I did some digging and sure enough back in March of 2006 I wrote about what could be a video EMR. Interesting to think how some things go full circle.