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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?

Steve Jobs and Healthcare IT – EMR

Posted on October 7, 2011 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.

I like I’m sure many of you have been a bit overwhelmed by the amazing outpouring of love that’s happened after the passing of Steve Jobs. It was weird for me, because I knew that Steve Jobs health wasn’t good but I was still a bit shocked to see on Twitter that he’d passed away. Certainly a major loss for his family, but the effect will be felt well beyond them.

I’ve been touched by a number of posts throughout the healthcare IT and EMR blogosphere. Here’s a roundup of a few of the Steve Jobs posts I found.

Jim Tate did a post that considers what if Steve Jobs had developed an EHR. Here’s one section:

For the past 5 years I’ve kept hoping that Apple would develop an EHR. One that when someone first used it they would say: “Yes, this is how it should be”. Whatever he developed and released to the world didn’t even need an owner’s manual. It just worked in a very human way.

I know I’ve written about the possible Apple EHR as well and what it might look like. As I read Jim’s post I couldn’t help but wonder if the reason Steve Jobs didn’t take on a project like an EHR was because our regulations and reimbursement don’t work in a human way.

Dr. Liu on Kevin MD wrote a post about Steve Jobs as a physician mentor. I love the idea that Steve Jobs was his mentor even though they never met. He offered this heartfelt thought:

I as a doctor I’m incredibly sorry that medicine has not yet evolved to the point that a cure exists for the rare type of cancer Jobs. I’m sorry that he is so ill at an incredibly young age, in his mid 50s, when many people begin to contribute even more to society with all of the knowledge and experience they’ve acquired. The future might be a little less bright without Jobs leading his team at Apple on creating products and experiences none of us truly knew existed until he showed them to us.

It is such a shame that he died so young. In fact, I’d say that might be the hardest part of it all.

The self professed Mac Fan boy, John Moore from Chilmark research, paid a tribute as well. He highlights some of the key things that Steve Jobs did with Apple products:
-Design aesthetics combined with functionality rule
-Supporting a renegade
-Systems rather than parts
-Supporting innovation

Yep, Steve Jobs will be missed in healthcare and well beyond.