EMR Customizations, Private Docs at HIMSS, and Solo Docs Going EHR

As I think I’ve mentioned before, I’ve been working on a redesign of my websites. The good news is that the redesign is basically complete. Sometime this next week (maybe sooner) I’m going to roll out the new design for all to enjoy. Yes, it’s only taken me 6.5 years to finally put a new design together. I like to say that I hate messing with something that works. I’m sure my critics will say…It’s about time. They’re of course right. Although, don’t get too excited. I believe it’s a huge step forward, but should still feel very familiar to regular readers.

UPDATE: I decided to just implement the new look and feel. If you’re reading this in a feed reader or by email, be sure to click through and check out the new threads on EMR and HIPAA.

Enough about that. Now, let’s take a look at our regular weekend roundup of interesting EMR tweets.

I wish that this tweet had some context. The idea of EMR customizations is an important one and I should probably cover it some more in future posts. The reality of EMR customizations is that every doctor wants it customized perfectly for them and very few of them want to spend the time doing it. That’s the hard problem that EHR vendors have in front of them.

I’m sure Bryan Vartabedian and Ron Hekier would love HIMSS. Particularly Bryan Vartabedian. However, they should be careful where they expect to get the most value. They’ll be overwhelmed by the number of vendor booths. They’ll be underwhelmed by the sessions. They’ll love the interactions with healthcare IT colleagues.

Interesting look at why this solo doc likes his EMR. His five reasons: The EMR is something new, Better Communication, Submitting claims, Documentation, and Patient engagement. I think the key takeaway from this article is that most doctors undervalue the little things that an EMR can do to make their life better.

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.


  • By way of disclosure, I am a Specialist (Breast Cancer surgeon) and I have been developing specialty specific interfaces for years. I have been using an EHR for the last 12 years that is no worse than any other EHR out there.

    Each Doc being asked to customize his/her own EHR, usually by creating individual or institution templates, is a tremendous waste of resources and makes systems no longer interoperable. The idea that each specialist or group of specialists should develop their own template is expensive, time consuming, and will produce a spectrum of extermely good to extremely bad templates for each specialty. In addition, these templates will result in data that is not interoperable and cannot be used for Clinical Decision Support, reporting or quality control.

    Lets look at Breast Surgery as an example. There are hundreds of EHR installs from 600 differnet vendors. Each install is being asked to create its own template (Does anyone see a problem here?). The surgeons play along at great cost in tiem and effort.

    A surgeon in Michigan has a field called breast lump and allows a yes/no answer
    A surgeon in Utah has a field called finding and one of the answers is lump
    A surgeon in Nevada has a field called right breast finding and allows lump as an answer (But that answer really means right breast lump)

    These surgeons cannot share data, they cannot use a common report generator to obtain certification or prove quality (Either might include breast lump as a parameter) and cannot use a common CDS system that helps in the management of lumps.

    What we need are specialty specific interfaces developed by specialists or vendors working with specialists. These interfaces should be able to be latched onto any EHR, rather than 600 vendors creating their own interface for every specialty. The pediatrician needs to see a different set of data then the neurosurgeon who needs to see a different set of data then the cardiologist. The workflow of each is different and thus the flow of the interface must be different. They use different decision support dependent on very different inputs, so the input interface for each interface is different and the interface to display the results of the decision support is different.

    Think of another life and death enterprise, modern warfare. Would you ask the captain of a warship and the soldier controlling a drone and the pilot engaged in air to air combat to use the same interface?

    The need for specialty specific interfaces is obvious.

    Now, the underlying database (What the EHR SHOULD be) can be the same for everyone. That is, there may be 20 fields in the EHR for all the ways a cardiologist might record blood pressure, and the cardiologist sees all 20, the vascular surgeon may see 10 and the internist might just see 3 or 4. There is no reason to show the surgeon 20 blood pressure types, nor is there a reason to hide those 20 types from the cardiologist.

    We need to move to a modular EHR, where each specialist has their own interface but they share a backend database.

    I have written about this as it applies to genetics and family history here:

    You can see some examples of specialty specific interfaces here:

    In reality, this is fairly easy to institute right now as the current EHRs are simply document repositories, not database. What I suggest is that specialists use specialty specific interfaces where they can do more work in less time and increase quality, and then dump a note into the EHR where anyone can read it. This is what is done by most specialty systems now, such as PenRad, and MRS for mammography, Powerpath for pathology, Metavision for anesthesia, etc. If you tool away those systems and made those specialists use EHRs instead, people would die.

    It’s time for the EHR vendors to understand that the goal is not to make it easy for the IT department to maintain a single system. The goal is to save lives.

  • New site look: I like it

    EHR customization: in a perfect world there wouldn’t be any, because all practices (by specialty) would follow the same time-efficient, profit-maximizing processes, and these would be what the provider programs into their system. Instead, every doc reinvents the wheel and refuses to change…hence customization.

    It is great the Dr. E loves his EHR, I think I’d be similar if I were a doc. Yet, he is unique.

  • Dr. Hughes and I must have posted simultaneously as I didn’t see his post before I wrote mine.

    He gives many more reasons that backup my belief that customization is a bad thing.

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