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What Are the Problems with EMR Documentation Today?

Posted on October 29, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

While at AHIMA 2012, I asked Susan Sumner, Executive Vice President of Ambulatory Services at Accentus Inc. about some of the problems with EMR documentation today. Here’s her video answer with her views on narrative EMR documentation vs point and click EMR documentation:

Fixing EMR Drawbacks

Posted on October 17, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

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.

EMRs and Templates: How to Avoid the Pitfalls of Boilerplating

Posted on October 10, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

On Kevin MD, there was a recent post about the problems associated with templating and John mentioned in his weekend EHR Twitter roundup. Some EMRs provide automation for notes so that a provider can check a few boxes regarding symptoms and have a patient note generated on the fly. While such a methodology works for a wide majority of patients a provider might see, it doesn’t for the one-off cases who present to the provider with certain problems and have something different going on. The author calls for a health IT products to function as decision support systems, meaning systems that allow for templating while at the same time encourage the provider to think through how a particular case might not fit the usual profile.

This study in Health Care Management Review pretty much comes down on templating. The study interviewed 78 physicians on how EMRs affect the skills of physicians. Yes, n=78 means we need to take this study with a pinch of salt, or more research is needed, but what’s revealed is pretty fascinating.

Physicians cut-and-paste too: Hey, I’m the last person to come down on using Ctrl-C/Ctrl-V. I’m doing it each time I write a blog post (albeit with attribution.) “A key dynamic with using EMRs involved the perceived ease by which a physician could use an EMR to “cut and paste” identical assessments of patients with similar clinical diagnoses or issues into several different patient records.”

It is better to get it “written” than right: Here’s something straight out of How to Write a Novel in 5 Days type self-motivation books. “The homogeneity of different patient visit notes convinced these PCPs that some physicians… favored the basic need to complete a patient EMR in a timely manner over the care management need to say something accurate and unique with regard to each individual visit.”

There’s way too much noise: Physicians interviewed recalled how specialists provided 6-8 line summaries of patients which contained everything a doctor needed to know about the patient’s visit – “[t]here was all signal, and no noise. Now as we review what specialists do in an EMR, and even what we do in primary care, what I miss is the narrative.” What you’re getting by checking a lot of boxes is copious documentation that says precious little, and makes you wade through the mire to get to the precious nuggets.

While I’m trying to poke some (I hope gentle) fun at the study’s findings, I’ve also been thinking along the lines of what features of an EMR system would help. One clue lies in the study itself: the physicians recalled how paper records forced them to dictate “certain amount of unique verbiage for transcription into a patient’s record.”

So maybe we need EMRs that:

  • combine voice recognition, so that the physician can continue to dictate patient notes
  • have Thesaurus like features to generate verbiage that at least uses interesting synonyms and phrases to give the appearance of uniqueness
  • don’t allow physicians to generate automated notes at all

What do you think will make things easier without boilerplating patient information?