Features of an EMR for Practical Use

For those of you who don’t read many of the comments on here and EMR and HIPAA, you’re really missing out. Some of the very best discussion and information comes out in the comments. At times I like to highlight some of the more interesting and thoughtful comments so that more people get to read them. This post is one of those comments where a doctor discusses the features that he believes should be included in an EMR that’s built for “Practical Use” as opposed to the meaningless “Meaningful Use.” I don’t agree with a number of his thoughts, but it does give you plenty to think about. I’m sure you’ll enjoy it!

Most of the charts look like:

Patient c/o cough.
HTN -controlled
DM – controlled
CHF – stable
No change in meds.

Those 5 short lines of text are the culmination of a clinical encounter and represent the result of a highly trained professional’s observations, conclusions and treatment plan. With the inclusion of patient name and date of service those 5 lines are the “Complete Medical Record” of that encounter. When Medicare or any other payer shows up to run a chart audit that’s all they want to see. There are certainly other documents like lab results that clinicians use in diagnosis and formulating a treatment plan, but those are simply part of the data “considered” by a clinician and are typically used once. That along with the more signifigant cognative data are processed through the clinician’s brain with the end result being output represented by those 5 lines of text.

When EMR products are designed around that work process EMR ubiquity is possible.

“Meaningful Use” is “meaningless” to clinicians.

“Practical Use” is easy to define, just ask a bunch of doctors who are resistant to the current generation of EMRs. What capabilities should an EMR contain at a minimum that would make it a “I’ve got to have that” clinical tool.

Here’s my list:

1. Must contain a textual clinical note.
2. Must contain a contextual/collaborative problem list.
3. Must contain a contextual/collaborative medication list.
4. Must allow access across enterprise boundaries.
5. Must not interfere with my existing documentation methodology.
6. Training should take no more than a coffee break.
7. Cost must be trivial like my cell phone service
8. Must not interfere with billing and administrative staff’s activities.

I already know how to write a clinical note.
I have finely honed cognative skills, don’t distract me from using them.
I already have a practice management and billing system.
I already get lab results electronically.
I already have e-prescribing.
I am not interested in drawing stupid little pictures on a screen with a mouse.

Finally an EMR must create a secure open channel of communication between clinicians.

I not going to spend $2,000 much less $100,000 to organize and share that information.

Doctors are not Technology Averse, they are Stupidity Averse.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

5 Comments

  • I’ll second an endorcement of the comments: you never know what you’ll find there. I remember the “practical use” one, wishing I’d thought of it (what a great catchphrase).

    I’ll have to say, while I see the benefit of clinical decision support (especially with drug interaction), every time I see a description of CDS I remember how much I loathed that “helpful” talking paperclip Microsoft thrust upon us all in an earlier version of Word. Sure, there were tips that might have been useful to me, but I could barely click my mouse anywhere with another tip popping up. Talk about a waste of time. My first mission when opening Word was finding out how to turn the paperclip off. If CDS acts that way, I have a feeling providers will feel similarly.

  • I understand Dr. Hendricks’ frustration, especially if he’s had an EMR not of his choosing imposed on him or if there’s been a lousy implementation. However, I take exception to many of his assertions:

    1. Must contain a textual clinical note.

    5. Must not interfere with my existing documentation methodology.

    And what is this methodology – the EMR should embody his approach and give structure to all the variations he maMust not interfere with my existing documentation methodology. Sounds like someone who doesn’t think about consistency. Searching his patients’ text notes would be a difficult chore.

    Who else has to follow his approach, has he ever explored alternatives or let anyone critique how he does things. I obviously don’t know him, but this sounds pretty closed minded.

    6. Training should take no more than a coffee break. This sounds like training is for the rest of my office, don’t bother me. If I had a client who was so stubborn , I’d suggest that they stay on paper and forget an EMR as a waste of money.

    2. Must contain a contextual/collaborative problem list.
    3. Must contain a contextual/collaborative medication list.
    4. Must allow access across enterprise boundaries.

    These are pretty SOP.

    Enterprise. Given the desire for an unstructured note, I wonder how much others in the enterprise would value what they get.

    8. Must not interfere with billing and administrative staff’s activities.
    7. I already have a practice management and billing system. Has his admin staff ever been asked their opinion? Again, sounds pretty closed minded.

    I am not interested in drawing stupid little pictures on a screen with a mouse. So, who is forcing this on him? I assume he is not in ophthalmology, GI or other specialty where being able to draw is highly desired.

    I not going to spend $2,000 much less $100,000 to organize and share that information. Does he pay for transcription or other wordprocessing now? How happy is he paying that?

    Actually, there should be a source of funds that should pay him for adopting a more structured system and I don’t mean the feds. His liability company has a direct interest in his producing a consistent, comprehensive record. They should give him a good discount for adopting a good system.

    If he doesn’t think EMR vendors make a good case, he should ask just about any lawyer who sues docs for malpractice. They love ad hoc notes in unstructured systems.

  • Question- 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?

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