Guest Post: Carl Bergman of SilverSoft, Inc. is a principal of EHRSelector.com.
My wife and I play a game called Write Only Files. The only rule is who’s first to notice that something’s been stored never to be retrieved. They come in all sorts of places. I once visited a nursing home that dutifully kept all the residents jewelry in a closet, but without any IDs. It didn’t matter; the owners never came back to claim them.
EMRs are not as dismal, but sometimes I think all we talk about is how to put data in an EMR without dealing with how to get it out. You’d think that the entire function of an EMR is to put in and retrieve single patient records.
Yet, a versatile, intuitive reporting system is absolutely necessary. Not only can it answer questions that paper systems cannot approach, but it also can produce insights into both medical and financial issues fundamental to a practice.
Stage 1 has changed some of this by requiring reporting on populations, not just retrieving single patient records. To deal with this, vendors have put on a full court press to modify their systems for Stage 1 reports. Their efforts, which often required new capacities, point out how neglected EMR report writers have been.
The need for more sophisticated and user oriented report writers is only going to increase. Stage 2, ACOs and other HIE initiatives will make even greater demands not to mention increased use of EMRs.
These external demands will be complimented by user demands for more information about the practice both medically and financially. Meeting these demands are a mixed bag of current systems. Some products will grow into these new roles while other vendors will need to rethink their approach or fail.
Current EMR report writers fall into three basic groups, of which only one can fulfill their role. These are:
• Wired Reports. These EMRs don’t have a real report writer; instead, they have single purpose “push button” reports for specific purposes. Users have little or no control over what they find or present. A typical report might show no show patients for a day.
• Parameter Reports. A step up from wired reports, these allow users a fair degree of control over what the report finds and some control over formatting. For example, the user may choose sorting order. These are often built in a tools such as Crystal Reports. Depending on the development effort, the result may be a robust tool. However, the use of third part tool can have major drawbacks. These include:
o Rigidity. Modifying a report may require an on site programmer or paying the vendor
o Cost. The user often has to pay for the tool, its annual license and maintenance. If there are problems, the user may be caught between the EMR vendor and the tool vendor.
o Conflicts. These tools are generalized applications designed to work on many different systems not just the particular EMR. Problems can range from not having the desired function to the tool ending support for the application type.
o Learning Curve. Users will have to master both the EMR and the tool’s way of doing things.
• Built In Report Writers. These are designed as an integral portion of the system. These overcome the problems of the other two classes; assuming they are built to meet a variety of reporting tasks. Even if a report writer can carry find and sort the desired data, it must also meet other requirements. For example, if the FDA issued a bulletin requiring practices to notify all their patients who have Crohns disease and take acetaminophen. The report writer should be able to identify these patients, email or prepare letters to them.
Even if an EMR has a crackerjack system, its mission can still fail if it does not have access to all practice financial data. Systems with a single database can do this. Those that link or coordinate the EMR database and the practice management db have a harder, but possible task. Those systems that have separate, uncoordinated, datatbases are out of luck regardless of how good the individual report writers may be. If a report writer can’t cross the EMR and PM line, it is not taking full advantage of practice data. Each time it can’t produce the needed reports it’s creating write only files for my collection.