Point of Care Systems vs EMR

Bob Brown sent out this interesting tweet about point of care systems that create EMRs.

Obviously, there are a lot of different ways to put together an EMR system. One is to create the system and then push it out to the point of care. Another is to create the systems at the point of care that then push back to the EMR system.

I agree with Bob that EMR systems were created first and we’re now trying to push them to the point of care. Sadly, most of them have done a pretty poor job of pushing the documentation to the point of care. Although, we have made some significant progress on this and will make more in the future.

With that said, I personally don’t think the real problem with useful and usable EMR is how they were created. The real problem with them is that we created big billing engines and now we’ve created big government meaningful use reporting engines. If we’d created an EMR focused on improving efficiencies and providing better quality care, we’d have a very different result. We might even have something that doctors would call useful and usable.

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.


  • Especially, and the Point of Care shifts, the current EHR House of Cards will become increasingly apparent. The point of care will increasingly be where the patient is in both location and understanding. At that point, “Patient-Centered” will actually have meaning rather than just be a buzz word applied to legacy Industry-Centric approaches and systems. This is a huge, pending culture shift that we are just starting to understand.

  • Both POC and EHR are patient care documentation perspectives. Mr.Brown is correct, that any medical chart documentation now includes billing, MU incentive dollars, JACHO medical credentialing standards, Best Practice guidelines, CMS population data analysis capabilities, HIPPA qualifications, acceptable reimbursement codes as aligned to respective diagnosis, as well as built in auditing tools to support proper practice, process and procedure as they apply to national patient care.

    The difference with the POC and the national standardized EHR is that the POC is uniquely interpreted by each given health system and/or physician. The standardized EHR leaves little interpretational digression.

    The EHR is a documentation tool. The medical information that was routinely entered in the prior hard copy charting is still the same. The EHR does not have to alter the F2F physician/patient dynamic. The EHR is the electronic version of the prior pen and paper form. The difference is that with the EHR your documentation is accounted for in a real time manner and does not allow for altered documentation timing.

    The primary documentation tasks for physicians is that of placing orders and constructing any of the 7 types of notes. These tasks are made easier with personalization capabilities, if the physician assimilates this option. Order sets can be preset and any of all their routine notes can be constructed to Smart List appropriate information directly from the chart to the note. The Smart Text also prepares all the notes in an organized, sequential, format that has been proven to increase readability and comprehension.

    My perspective and commentary is from the Epic EHR. The EHR is here and has now become the standard for concise, timely medical chart documentation. All the time spent trying to deter or dismantle the new nationally acceptable medical documentation standard only serves to delay mastering the process with subsequent assimilation into one’s workflow.

    With any change, engagement, practice and mastery diminish the scope and intensity of the alteration. The EHR is being implemented in every hospital and clinic, both nationally and internationally, with growing numbers of doctor’s office adopting and implementing a complimentary office EHR system.

  • John,

    Thanks for posting – and bringing attention to — my recent tweet. Here’s the story behind that tweet.

    Since our involvement as investigators in an AHRQ sponsored research project to define an information model for the PCMH, Steven Waldren (@TechyDoc) and I have been investigating interactions and information flows in healthcare. After the AHRQ project concluded we decided to continue researching the subject on our own and outside our regular day jobs; me at Mosaica Partners and Steven at AAFP. We were intrigued by what we found.

    To cut to the chase, we’ve identified the six high-level lifecycles/flows (from the perspective of medical informaticists, systems designers, and network engineers) that meet, converge and interact at the point of care. They are:

    – Patient
    – (Patient’s) Issue(s)
    – Site/Setting(organization / physical location where care is provided)
    – Role (of individual interacting with the patient)
    – Individual (the unique healthcare provider(s) interacting with the patient)
    – Function (the function or procedure being performed).

    Each of these six lifecycles/flows consists of rules, policies, preferences, manual & automated workflows, processes, and historical information. All influence – and react in one way or another – to the activity that takes place at the point of care. During the activity at the point of care, new data and information is generated. That information can be capture via feedback loops to improve each of the six related knowledge bases.

    We believe that these six lifecycles/flows represent the foundational information flows that comprise the learning health system as envisioned by the larger healthcare community. In an optimal world, the IT systems would accommodate and support all six of these lifecycles/flows.

    Building EHR systems on top of older billing systems probably sounded like a good idea back in 2004, in response to then President Bush’s directive to have electronic health records by 2014. Now, ten years later and with billions of dollars spent, it would appear that wasn’t the best design approach. In retrospect the path taken was far from optimal. It’s time to get on a new path if we are to achieve the Triple Aim, something we just can’t do without good information.

    We want to contribute our research to the larger healthcare community so that this new generation of health IT systems can be specified, designed and implemented. For more information on our research and our plans, visit http://www.TheCUREProject.org.

  • Bob,
    Thanks for the added insight into what you’re doing. It’s definitely a complex beast that we’re trying to tackle. I’ll be interested to see how your efforts do going forward.

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