EMRs Can Spark Creativity

Today I’ve been letting a few curious little theories germinate in my head. So I thought I might try out an idea on you good folks.  For those who have read my previous rants about breaking a doctor’s workflow, this may seem rather contrary, but hey, we can always duke it out later.

Yesterday, I went to see a specialist who’s a member of a decent sized practice (about a dozen docs, give or take).  The office is completely paper-based, efficiently and elegantly if my patient’s eye view is any indication.  The practice is something of a zoo — super-high volume — but I seldom if ever feel rushed or impatient.  In other words, we’re talking what looks like a pretty well-run shop from the pre-EMR era.

When I saw my doctor, we puzzled together a bit over a medical issue I’m facing, one which could be drug-induced or could be organic.  We spent some time talking about standard solutions and how to manage them and then, boom, my specialist had an inspiration.  We agreed that I should taper off one medication and begin the other shortly.

Luckily for me, my doctor was engaged and seemed interested in digging into the problem.  But in other cases, realistically, I might have gotten a physician that stuck blindly to the obvious and didn’t dig up what might be a slightly unconventional solution.

Here’s where I contradict myself to some degree.  In past essays, I’ve written on how inelegant and undesirable it can be to break physicians’ workflow for the sake of squeezing an EMR into place. I’ve argued that EMRs should be designed for physicians and not for administrators. And so on.

This encounter, however, convinced me that when EMRs break passive, standard workflows, it could be a spur to creativity in some cases.  In the right situation, if the doctor I saw was distracted or bored, the EMR could throw second line solutions at him or her just when they were ready to e-prescribe and sign off on the visit. (Yeah, a “do you want to leave this chart now?” prompt with a med recommendation might be annoying, but it could be productive!)

Of course, no system can force a physician to engage if they simply don’t want to do so, or don’t have time to think. But if the system is designed right, maybe the changes EMRs engender can lead to fresh ideas, better grasp of details or just a reminder on a bad day.  At least I hope so. What do you think?

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

6 Comments

  • Great post, Katherine!! Doing something in a new way often does spur creativity. In medicine it could allow more “in the moment” thought processes instead of “routine memory”. Nice!

  • Today’s crop of EHRs do not do what you describe. Unfortunately, you are giving credit to them that they do not deserve. This is dangerous, as if people think EHR s do things as you describe, some government bureaucrat might start spending 27,000,000,000 dollars of our money pushing their use.

    Oh wait, that already happened!

    EHRs lack the functionality needed to improve medical care in the way you describe. Please do not mislead people.

    We need to be honest of how much functionality is needed, how much is missing, and how we fix it. Paying docs to use substandard EHRs is not the answer. And saying the problem is already solved is not the answer. The first step, is recognizing that we have a problem.

  • I’m not sure we’re ready for creativity in EHR’s, but I believe that in some practices they can and do make a difference. For instance, a hospital based endocrinology practice that deals with young T1D’s, where it is critical that the staff not miss ANYTHING during the history update and exam. Not any tests, not any numbers from the pumps, etc. Accuracy and completeness are extremely important in keeping the patient’s conditions under tight control.

    Now for an allergist, not losing track of test results, not forgetting when to redo tests, keeping close track of what meds work – and what don’t, tracking illnesses and extra meds prescribed – all important.

    Now try hematology. There’s an illness where the first line defense is cortico-steroid based. There is a protocol, but I’ve seen how it gets forgotten or mis-communicated when one doctor assumes that others knew and understood it, but really don’t. Steroids can be incredibly helpful but have bad side effects, and in this case it may be that blowing the protocol left a patient with permanent side effects that might have been avoided.

    The point being; EHR with good communication and careful use and effective use of all it can do can greatly improve the odds of ongoing good outcome. Even a practice with a great paper system will have failures caused by an inability to fully work as a team with a patient’s doctors and pharmacy and labs outside the specific practice.

  • Anthropomorphism is the assigning of human thoughts or capabilities to non-human animals.

    We need a term for assigning functionality to EHRs where that functionality does not actually exist.

    Per R Troy comments are shown in quotes below with my response after:

    “For instance, a hospital based endocrinology practice that deals with young T1D’s, where it is critical that the staff not miss ANYTHING during the history update and exam. Not any tests, not any numbers from the pumps, etc. Accuracy and completeness are extremely important in keeping the patient’s conditions under tight control.”

    Agree. What is needed is to enter this data with structure and have CDS be sure all bases are covered and nothing is missed. This functionality does not exist in any EHR but there are likely niche software modules that could do this quite well. EHRs should link to those functional modules.

    “Now for an allergist, not losing track of test results, not forgetting when to redo tests, keeping close track of what meds work – and what don’t, tracking illnesses and extra meds prescribed – all important.”

    Agree. What is needed is to enter this data with structure and have CDS be sure all bases are covered and nothing is missed. This functionality does not exist in any EHR but there are likely niche software modules that could do this quite well. EHRs should link to those functional modules.

    “Now try hematology. There’s an illness where the first line defense is cortico-steroid based. There is a protocol, but I’ve seen how it gets forgotten or mis-communicated when one doctor assumes that others knew and understood it, but really don’t. Steroids can be incredibly helpful but have bad side effects, and in this case it may be that blowing the protocol left a patient with permanent side effects that might have been avoided.”

    Agree. What is needed is to enter this data with structure and have CDS be sure all bases are covered and nothing is missed. This functionality does not exist in any EHR but there are likely niche software modules that could do this quite well. EHRs should link to those functional modules.

    “EHR with good communication and careful use and effective use of all it can do can greatly improve the odds of ongoing good outcome.”

    That EHR does not exist. It is best if we point out the need for the functionality you describe and then state clearly that this functionality is lacking in today’s EHRs and is not even on the horizon. We need to start being truthful about the failures of today’s EHRs if we want to find a solution. With alcoholism, the first step is admitting there is a problem. The same goes for developing good EHRs.

    To give them credit, EHRs are great filing cabinets accessible from anywhere. This has value. But just because these vendors can do that does not mean they should have a stranglehold on innovation in Clinical Decision Support. To use an architectural analogy, just because a company can build a skyscraper does not make it the best company to design fine jewelry.

    EHR vendors can manage big infrastructure. Leave the fine work to others.

    For full disclosure, we have been developing HughesRiskApps.Net for years with the goal of improving the quality of care while decreasing cost and workload. The software is free at our website:

    http://wp.me/P2k9JX-18

    TheBreastCancerSurgeon.Org

  • Kevin…looks like your software is heading in the right direction. I love the linking of former patient families to current ones. The “synthesis of mutation risk” slider is a great tool for the breast cancer physician. Also, the “multiple scenarios management” suggestions is brilliant. It is that sort of CDS that will spur creativity and really upgrade the quality of care.

  • Kevin,

    I’m an IT guy whose had piles of interaction with hospitals and doctors for many years starting in my teens as an ER volunteer. I’m no clinician, but I’m very impressed with what you have. And I feel a bit depressed because what I’m being taught about HealthIT clearly is not quite living up to reality. But I have to note after going through the link you provided and reviewing the cancer PowerPoint that I’m very impressed, because to me this is what EHR, etc. should be about.

    It answers a number of issues. It pulls in a pile of relevant history and is designed to not waste the time of the clinicians. It also does risk assessments and provides a road map to the clinicians and patients. Clearly, this is a big part of where we need to be going. EHR’s should not just be about better billing, but about helping patients and making best use of medical resources, and making sure that patient data is available where, how and when needed.

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