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Intelligent Healthcare Information Integration 11/5/10

November 5, 2010 News 4 Comments

But What Do I Know?

I’ve been looking at a whole lot of EHRs and their web sites lately, looking for my "next great system." Maybe they’re just starting to blur together in my brain, but it looks as if every single EHR out there will improve my workflow, decrease my errors, increase my productivity, improve my bottom line, get me home earlier, make my life easier, and guarantee my MU bucks. Somehow the redundancy of hype doesn’t increase my interest…but what do I know?

Back in 2004, I remember thinking that the majority of EHRs looked a whole lot like Windows 95. Not much has changed. I used to think that most EHR developers would soon learn the value of style, of "eye friendliness" for meeting the wide variety of end user tastes, or that at least they’d develop "skinning" for their systems to help solve the problem of ugly EHR user interfaces. I remember thinking how much better they’d all look within the next five years…but what do I know?

I remember when you moved from one medical practice to another, from one type of paper chart to another, and it took all of about thirty seconds to figure out what went where and how to find the info you needed. Seems that the multitude of "modern" electronic charting systems could stand to be reminded of that…but what do I know?

Seems as if every report I receive via fax or hard copy from (fill in the blank) EHR is either way too long and filled with mostly irrelevant "filler" data or way too short and lacking essential, clinically valuable elements. Seems as if very little effort is being spent, at any level, on truly defining what clinicians actually "need" and how to make that information apparent, easily visualized, and perhaps even somewhat standardized when it comes to knowing where to look for any given piece of info…but what do I know?

Doctors used to be paid for their knowledge, for their experience, for their clinical skills, and their wisdom. Nowadays, it seems we’re paid mostly for data capture. I think patients still want good “doctoring”…but what do I know?

It may just be me, but there appears to be an increasing similarity between how insurance companies deal with clinicians and how more and more EHR vendors are starting to treat us…but what do I know?

I read that independent providers aren’t flocking to EHRs quite as much or as fast as hoped despite the ARRA/HITECH incentives. I’m thinking it might be because of some of the above concerns and just how difficult it is to actually change virtually everything about how you work while you’re busy actually trying to do the work…but what do I know?

For myself, I’m also hesitant to make another EHR choice. Having lived through three EHR company acquisition-mergers which eventually led to the Kevorkianization of a really smart, sexy system that was just reaching a respectable maturity, I’m pretty sure more this same digital tragi-drama will happen to many other decent systems over the next few years…but what do I know?

Don’t get me wrong; I see systems which do some things very well and I know a whole lot of EHR vendor folks who I think are just plain wonderful. Good people and good intentions are important, but I’m still thinking I want a beautiful system that works as easily as my iPad and as intelligently as WebOS, one that I can start using as simply as I need and which can then be "apped" silly at my discretion, one that is actually as good and as smart as all the hype…but what do I know?

From the trenches…

“Committee – a group of men who keep minutes and waste hours." – Milton Berle

Dr. Gregg Alexander, a grunt in the trenches pediatrician, directs the “Pediatric Office of the Future” exhibit for the American Academy of Pediatrics and is a member of the Professional Advisory Council for ModernMedicine.com. More of his blather…er, writings…can be found at hisblog, practice web site or directly from doc@madisonpediatric.com.

Comments 4
  • EHR vendors can be likened to movie trailers – all flash and bang set to a really groovy beat. then you pay to see the hype and realize all the best parts were shown in the trailer….

    love your column and it’s musings!

  • Seems to me that “Certification”, under CCHIT, started out as a seal of assurance for providers…that an EMR had the functionality, security and HIPPA provisions…that ANY product should have. It was meant to HELP providers decide which product was best for their practice without having to worry about anything but implementation, usability…and price.

    In implementing EMR, providers had expectations of the chance to improve their workflow and reduce some costs, but it required that leap of faith that Dr. Alexander talks about…in the way providers collected and documented the data associated with each exam. Learning curve there. Providers still did whatever THEY thought was necessary during the exam. And if some things took too long to document using the EMR…then they were skipped, recorded by hand or noted some other way.

    And just as providers started to recognize the merits and shortcomings of “certification”, along came “Meaningful Use”…and changed everything. NOW, the focus has shifted to what a provider MUST COLLECT and BE ABLE TO REPORT ON. No more options to skip the things that took too much time or were too troublesome to learn how to do.

    To compensate for this, “incentives” were offered to make up for the costs…of which loss of productivity would be the largest one for many providers. Now, virtually ALL providers who expect to get the incentives will need to document a plethora of things during exams they may not have been accustomed to doing with an EMR…when it was “optional”…their choice.

    And not only that…the “incentives” also contain the threat of “dis-incentives”…some penalties (reduced reimbursements) from CMS looming out there for those who choose NOT to “meaningfully use” an EMR to document and report data with. Some even worry that the private payers will eventually follow suit, given they usually parallel what CMS does.

    So the issue now is…not WHETHER a provider should use an EMR…that has pretty much been decided…but how do providers decide WHICH EMR to use? Seems to me that using the EMR with the most experience in their specialty, that makes the best use of their time and makes data collection easiest and least disruptive to their normal routine would be the one they want. But What Do I Know…?

  • Seems like you guys know quite a lot!

    I’m a big fan of the ONC. I think the vision it created for a wired health system is largely correct and right-minded, and it represents a huge step forward, especially c/w the previous vision as promulgated by the old CCHIT criteria.

    That said, 2 things not covered by the ONC’s EHR certification criteria are potentially glaring oversights: the usability and safety of EHRs.

    Usability is ultimately going to be a specialty-specific phenomenon, at least for many specialties like Oncology, Ob-Gyn and virtually all of the surgical subspecialties. In these practice environments, the workflows are unique and specialty-specific (e.g. infusion suites in oncology offices). It’s going to be nearly impossible for a one-size-fits-all user interface to accomodate them all.

    As for safety, ONC clearly has this on its mind (as does the FDA). On balance, I have no doubt that EHRs are a “net positive” when it comes to improving the quality of care and patient safety, but the continuing stream of published reports about quality of care/safety issues associated with EHRs (mostly derived from hospital settings) should give us all pause.

    I’m hopeful the ONC can address these issues as it steps to the plate and begins designing its Stage 2 MU criteria.

    Glenn Laffel, MD, PhD
    CEO Pizaazz

  • I think your comments on the state of EMRs is right on. There are many EMRs that use impoverished information models. Like you I heard of one major EMR vendor that bought up some very nice niche vendors and I thought that the resulting product would be really good but it was a kludge that forced the user to jump around all over the place to get things done.

    The other big issue is the general appearance of EMRs is so very dated. Haven’t the EMR developers heard of ‘information visualization’. There are conferences on this and the the issues discussed seem to be decades ahead of what we see in the current EMRs. There is the CUI or common user interface developed in the UK with Microsoft. This provides a lot of information on what interfaces should look like but no vendors have picked up on this.

    The challenge seems to be how to record the knowledge and wisdom of the physicians into a data field?

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