A List Of Must-Have EMR Features

When a doctor tells you what features they believe need to be in an EMR, it’s worth a listen. And when that doctor has personally managed the ongoing development of their own EMR, I find their ideas to be even more interesting.

Such informed recommendations are just what Hayward Zwerling, MD, has to offer. Zwerling is a practicing physician, and also the creator of the ComChart ambulatory EMR, which he launched in 1990 and kept on the market until 2015. Zwerling recently published a list of features which, he argues, should be in virtually every EMR. Below, here’s a sampling of his suggestions:

Lab features:

  • Provide a button displaying all abnormal lab results, and make the resulting list sortable by test name, test date or any other available parameter.
  • Allow the physician to display any subset of the patient’s lab results, and offer an option to omit individual results and resort the displayed data. Also, allow doctors to export the data in cvs or Excel format.
  • Permit doctors to create lab test charts on the fly, including any combination of tests from the patient’s existing lab work. In addition, make it possible to incorporate this chart into a Progress Note approved up to chart for the patient.
  • Make it easy for the doctor to create an association between incoming test results and specific medicines. (For example, if a cholesterol test result appears, include the name of any statin the patient currently takes.) And make it possible to create lab charts which include concurrent medication information, with just one click.
  • Clearly display who ordered a test and to whom a copy of the test was distributed.

Progress Notes:

  • Allow physicians to create test result charts from within the Progress Notes section.
  • Permit physicians to add selected free text from the Progress Notes to the problem list, medicine list, allergy list, family history or old problem list by highlighting the data and clicking a single button.
  • Create a free text field on the Progress Note layout allowing doctors to enter information that is not an official part of the patient’s chart. For example, the clinician might write a note such as “Daughter wants issue of her mother’s depression to be discussed at the mother’s next visit, and daughter does not want to be identified.”
  • Allow doctors to search free text Progress Notes for a word or phrase. Also, make it possible to search some or all of the entire EMR’s free text Progress Notes in this matter.

Zwerling goes on at much greater length in his post on The Health Care Blog, so much so that his suggestions spill over into a separate blog entry. But this subset of suggestions make the point on their own. He clearly believes — quite reasonably — that doctors should have access to simple, easy-to-understand tools when they use EMRs, and that there should be no need to refer to a manual or attend training classes.

He sums it up thusly: “The feature should be presented to the user in a manner which make it intuitively obvious how to utilize the feature.” Really, don’t we all agree with him? And if so, why are so few EMRs organized this way?

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.

3 Comments

  • Really, don’t we all agree with him? YES
    And if so, why are so few EMRs organized this way? MU and Regulations and IT making EHRs for billing not patient care

    Dr Z should be on the ONC/CMS committees. There are a few of us out here that use customized EHRs, and Dr Z even sold a great one for years. But HITECH hijacked the Custom EHR market. Yes NON certified.

    I wrote to Andy S that we should have a Custom IT Group in MACRA. Do not penalize us and let us work with our own custom built NON certified EHRs. Compare our results, quality, costs, safety, satisfaction to ANY other proposed program. It would be a knock out success. Our patients are better cared for, products more secure, much better efficiency/quality/safety/usability and markedly less burden on providers as we get the info we need, how we need it. Vendors work with MDs directly and not hamstringed by MIPS/ACI/PQRS/Quality measures/MU, etc etc.

    Its the Healthcare 3.0 that is the future. No more hyperregulation, complexity, and ginormous government programs that have been driving us backwards in all categories, from safety, security, usability, efficiency, burden, burnout, satisfaction, treating the computer and not the patient, those days are going to eventually come to a close. And EHRs will actually be made to work for us, instead of the reverse. Big Factory Machine medicine will never work. And that is what MACRA is driving us to…Big groups, big data, factory medicine. It will never work.

  • I have a fundamental problem with the approach of a ‘List’.

    There are (and were) EHR systems out there that were close to a full feature list. Yet, we see failures of implementations of the same systems, providers and practices unhappy.

    The problem is that features don’t solve problems. Solutions solve problems. Don’t we know of some practices that manage well with Practice Fusion?

    Practices must start with their workflow, and desired workflow optimization and then try to looks for systems and features that help them achieve the desired outcome.

  • Whatever the EHR is capable of doing, it’s equally important that it be configured to do it, and then actually utilized effectively. For instance, you want to analyze lab test results. That’s great, I can imagine how it could help in many cases with treatment of long term illnesses to spot trends, for instance. But this assumes that all the data is usable. For instance, I recently noted how one major hospital system in the NYC metro area has not paid for its EPIC to be connected to Quest labs (I have to assume its available). When results get FAXED in to an office, they are SCANNED into an image attached to the EHR and the actual individual results are NOT entered into the record, hence that data cannot be charted (nor is it available via the portal). Big, fancy, expensive system that because of this issue cannot be used for basic patient trend analytics, and cannot help the doctor figure out what’s going on. Ignoring MU and billing, kind of a huge waste of time and money when such a system does not contribute to patient care.

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