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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.

July 15, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Building Usable EMRs: What About The Patient?

I think most of us reading HealthcareScene.com blogs like this one would agree that for EMRs to become more usable, the process of developing them will have to change.  Specifically, everyone seems to agree that if vendors and physicians don’t work together on usability, we’ll end up with with system after system that nobody wants.

But what about patients? Do they have a role in making sure EMRs are usable?  According to Jon Mertz, the answer is a definite yes.  As Mertz sees it, it’s not good enough for vendors and physicians to talk shop to one another — patients will have to be part of the conversation.  I think he makes a lot of sense.

Talking with EMR vendors is a good way for physicians to get more of what they want, but it’s not enough, Mertz argues, I think quite persuasively. It’s also important for physicians to ask patients want to see in an EMR, especially so given that patients will eventually have access to all of that information. “Patients add an essential perspective to how an [EMR] should be used,” Mertz writes. “It is a system to serve them and their care.”

Vendors should also be talking to patients as well as physicians, Mertz suggests. “Even though physicians, clinicians, and administrative personnel are the primary users of an EHR, their solutions benefit patients, too. Information in an EHR will be viewed and carried forward by patients, so they can provide a valuable perspective on usability.”

The final step in this cycle is to develop a patient base which actively uses EMR data and is quite willing to offer feedback on how the process is working. Specifically, they need to be capable of letting hospitals, physicians and other providers know how their access to data is working, especially if the form they’re getting in doesn’t serve their needs.

I really appreciated Mertz’s take on getting patients involved in the EMR usability process. It’s a point that doesn’t get made often enough — and will definitely need to be talked up more in the future. After all, without patients feeling comfortable with their data, the ultimate goals of Meaningful Use aren’t attainable.

November 12, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

37 Seconds To Chart Encounter on Peds EMR

If you’re like me, you’ll probably be a bit surprised (pleasantly) by the following video, which can be found embedded in an equally interesting blog post on EMR feature-creep or “featuritis” by Dr. Charles Webster.  (I would have shared the video here but it’s only available on Dr. Webster’s site.)

In it, the ever-insightful Dr. Webster details how a peds practice has gotten to the point where a routine encounter takes 37 seconds to chart using the practice’s pediatrics-specialized EMR, as follows:

1:08 I open the chart
1:13 Chart my physical exam, my pharyngitis exam
1:19 Chose my diagnosis of strep pharyngitis
1:25 Make my treatment duracef and follow up in 3 days
1:31 Write my prescription
1:33 Edit my follow up if necessary
1:37 Have created a beautiful chart
1:42 Check my billing
1:44 And I’m finished

That may sound extreme, but it’s not, he says. “I’ve looked at timed studies of our current physicians’ charting at  pediatrics or family practice, and the average chart for a sick visit is 28 seconds,” he notes.

As if that wasn’t sensational enough for an audience expecting EMRs to make everything tougher, he had more to share.
“In reality, with a finger or a stylus you can do this in about a third the time,” Dr. Webster told them.  In this case, that would mean 17 clicks in 12 seconds, but people can generally tap their finger at that pace with little trouble, he says. Not such a big deal.

That being said, it seems likely that going forward, doctors will need to better develop the cognitive motor skills of musicians — the ability to step up eye-hand coordination to be sure —  if they want the best results out of their systems.  Dr. Webster says he’s planning a future post which critiques EMR data and order entry from the point of view of psychological models of musical cognition, learning, and motor skill. I think I’ll want to catch that one!

September 11, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Ross Koppel Poses Questions About Safety and Usability of Health Information Technology

I was told that Ross Koppel gave a presentation at the NIST conference on EMR usability. In his presentation he covers several important issues of data entry and its impact on patient safety. In particular, he talks about a study he did on the problems of bar codes he found in hospitals. Turns out there’s a presentation by Ross Koppel on YouTube that is close to what he presented at the NIST Conference. See embedded video below:

Ross Koppel brings up some interesting points about patient safety and health IT. What do you guys think of his presentation?

May 25, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.