I’ve written many times on EMR and HIPAA about the need to fix the internal workings of your practice before you implement an EHR. The problem being that technology like an EHR work like a great magnifier of any problems with your practice. Something that you may not have noticed as an issue in the paper world can often become a major problem in the EHR world. Not because the problem shouldn’t have been fixed in the paper world, but because you didn’t realize it was a problem.
The core point being, “EHR Technology doesn’t solve bad processes.”
With that as background, I started to think about this from a hospital perspective. Yes, in a small practice it’s much easier to evaluate the relatively simple workflows and dramatically improve them. The same thing is MUCH harder in the incredibly complex hospital world.
In the hospital environment, I expect there are always processes that need improvement. Plus, in many cases the health system is so hardened into its current practices that changing those workflows is almost impossible. This workflow hardening means that hospital EHR vendors are often beholden to old, outdated processes and workflows.
Related to this problem is the view that many hospital EHR vendors (Epic being famous for this) hold about implementing one system across the entire hospital. While you can certainly see advantages to one system, I think a major downfall is that it often means that workflow improvement is much harder.
Those ED EHR vendors have certainly seen this first hand. Imagine how much time and focus a one size fits all hospital EHR spends on an ED EHR module versus an ED EHR vendor that only does ED EHR software. Which of those do you think has a better chance of helping an ED get to the optimal ED EHR workflow? The answer is obvious. Now extrapolate this same concept to the thousands of other workflows that exist in a hospital.
We’re more likely to see hospital innovation from a number of scrappy highly focused startup companies than we are from large hospital EHR vendors. Although, the smartest hospital EHR vendors will realize this and will open themselves up to scrappy highly focused startup companies to iterate on top of their hospital EHR platform. Too bad far too many are focused on putting up walls as opposed to creating highways.
You explained something for me; why hospitals get 2 EHR systems, one of them being for the ER/ED. But I see that as an even bigger problem. The 2 systems may well not play well together, but ER patients 1. often end up getting admitted, and the records seen in the hospital EHR need to include those from the ER, 2. need services from various departments like labs, pharmacy, etcl, 3. should still be given one bill, etc. for their stay including the ER. I see ER’s as one of the two main entrance portals to a hospital (admitting being the other). A third might be for outpatient treatments and surgery. And patients of any of the 3 sooner or later may use of of the other two, or both.
I’d much prefer one system but with a module properly designed for ER needs, including optimized dispatching for labs, radiology, ekg, etc. Where an ER doc does POS entry tha t quickly leads to assorted orders for tests and quick return of results, then quick treatment, patients get discharged or sent to the floors much faster, thus freeing up high value ER space. And with the EHR records being fully available for in house use for admitted patients, that can save piles of paper and avoid lots of mis-communication. And maybe well thought out analysis of the data might lead to better predictions of needed staff and in-patient beds.
The problem is just as you describe. The problem isn’t that they are separate systems. There are really good advantages to having separate systems. The problem is getting those systems to talk to each other and share data. However, this problem is not technical in the least (it’s been solved technically). It’s a problem of vendors creating closed gardens and not enabling the sharing of data between systems.