EMR Landmine, Mobile EMR Access, and Patient Advocates

While it seems that many people are coming out with distaste for the Olympics, I am still on the side of enjoying the Olympics thoroughly. I’ve watched as much of the coverage as possible. What can I say, I’m a sucker for pretty much any sporting event. I hope everyone else has been getting as much joy out of the Olympics as I have gotten, but I digress.

As you know, each week I take a quick look at some interesting tweets that have been posted around the EMR, EHR and Healthcare IT twittersphere. Plus, I’ll add a little commentary that will hopefully start some interesting conversations and help you as a reader.

What a perfect way to describe the issue: an EHR Landmine. Jane Shuman is exactly right too. In fact, a local doctor recently told me the same thing. The challenge of checking and re-checking patient information from a previous patient visit is a huge problem waiting to happen. I think the doctor I talked to said that EMR perpetuates mistakes. It’s so true. I wonder what other EMR landmines are out there.

My readers agree with Melissa. As long as the iPad is a native iPad app and not just some remote desktop access to EMR software that isn’t optimized for a tablet environment.

You have to love Regina Holliday. A tireless patient advocate. Years down the road I hope that Regina will be able to stop her patient advocacy. Not because she gets tired of doing it, but because we embrace the patient in healthcare.

About the author

John Lynn

John Lynn

John Lynn is the Founder of 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.


  • I agree, we should go back to the old day and ask the doctor to use paper notes. They should go through the entire old chart to find relevant information, meticulously copy the key information into the new note, and then add the information from today’s visit. That is way faster than having some computer search the record for you, and hand-writing it in yourself is much more legible and of course you never transpose a digit.

    Or maybe we could use a tool that automatically pulls key information forward to us that we can review, edit and include or not into the note. But that would take an extra 5 seconds of the visit to look at. No, much faster and more accurate to just use good old paper.

  • I love a good sarcastic comment Joe K. Of course, I’m not advocating going back to paper. Although, I am warning for landmines associated with EHR that we should see and deal with appropriately.

  • So you could see my tongue firmly planted in my cheek! You are correct that there are landmines there – the key is in reviewing the data that’s pulled forward and using it properly. I still think that using a well-designed EMR documentation tool is the best way to get a better note. There is risk in mis-using any tool, and the EMR is no different. A poorly implemented or poorly used EMR just lets you do the wrong thing at the speed of light.

  • I had a talk today with a doctor I know. She has 2 locations, one of them essentially a part of another practice where they use Eclipse. She uses nothing in her solo practice that I know her from.

    She told me today about her experience with Eclipse. I don’t think she dislikes it, but there’s never time to get her the customized templates she needs. She finds it slow and awkward, still takes all notes by hand, and then when she gets a break she types everything in. She finds it all a huge waste of time. And did I mention; she’s fairly computer phobic?

    Now I see her solo practice from a different view then her. Everything is on paper right down to appointments and payments. The PC running XP is turned on but never used because it does not have enough RAM for today’s browsers. She takes forever to scribble down her patient instructions and prescriptions, none of which are really readable. She never knows for sure what formulary issues may arise. She can’t easily track patient results over time, and she has a huge stack of paper charts.

    I’m no expert on Eclipse. I’ve no idea of how good her training was, how hard it might be to use. So I don’t know if Eclipse is the problem, or just her resistance to computers. I know it’s unlikely I could persuade her to adopt an EHR for her solo pratice, but I feel bad for her difficulty in using what she has already.

    Land mines? Yep, lots of big ones and that’s just with one doctor. BTW, she’s very smart and capable – just doesn’t like computers or anything on them. Now imagine trying to migrate a large practice to its first EHR – or a hospital! I can see an environment that makes EHR implementation almost as hard as fighting the Vietnam war!

  • The exact point of reviewing pulled data before committing it to your patient’s chart was a recent point of contention with a colleague of mine. We both agreed that in a perfect world, all doctors using an EMR system capable of pulling a patient’s data from encounter to encounter would review the pulled data line by line and decide what should remain in the current encounter and what should be discarded in favor of new data. However we all know that this is not the case, and I shudder to think of the amount of electronic medical records out there now that contain inaccurate data because of this issue.

    The factor that most contributes to this issue I think is that most users of any computer system just expect things to work the way they expect. After all, if I’m charting a routine physical exam, of course there are parts I would want to recall and parts I would want to start fresh, and of course the EMR should just know what those are without me having to tell it. A more apathetic man than myself would say that if you give the user the tools to pull, discard, pick and choose, and enter data from scratch, then it’s only the users lack of diligence that leads to errors in the chart. A joke in IT when discussing a user’s question of why the computer doesn’t just do what they want it to do is that, “yeah, we’re getting right on that mind reading interface, it’ll be ready pretty soon.” But as silly as that sounds, I don’t think that’s too far from the mark. I think that an EMR or any computer system in general can be designed to learn from theirs users and provide an experience they expect without the user having to go tweak a thousand settings beforehand. However as John remarks often, so many EMR developers out there are overburdened with making sure they are certified and meeting standards that they don’t have to time to break new ground in design.

    Another issue in the same vein as this that’s worth writing about some time is the errors in charting that result from template’d EMR’s not only pulling data from a previous encounter, but assuming the patient is perfectly healthy from the outset and letting the user, “just change what’s different.” Are you really telling me you do an all normal 14 point review of systems and full physical exam every visit?

  • Andrew,
    Nice comments. I love the mind reading interface joke.

    It is true that there are two sides to the coin. Or maybe I should say land mines on each side. If you don’t provide them the information, it’s a land mine. If you do provide it to them and you shouldn’t it’s another land mine. Very interesting.

  • Actually there are already patient advisory committees at nearly all major health care facilities . In fact half of all federally qualified community health centers.

    For some reason one or two patients (tokens) with unusual stories and have become the token patient voice (when in fact their experiences are anything but typical) are clustered around health IT (perhaps because that is where the money is) when in fact they really should be working in healthcare itself if they want to bring about change.

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