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10 Ways to Make the EMR Meaningful and Useful

I am an EMR geek who isn’t so thrilled with the direction of EMR.  So what, I have been asked, would make EMR something that is really meaningful?  What would be the things that would truly help, and not just make more hoops for me to jump through?  A lot of this is not in the hands of the gods of MU, but in the realm of the demons of reimbursement, but I will give it a try anyhow. Here’s my list:

  1. Require all visits to have a simple summary.
    One of the biggest problems I have with EMR is the “data diarrhea” it creates, throwing piles of words into notes that is not useful for anything but assuring compliance with billing codes.  I waste a huge amount of time trying to figure out what specialists, colleagues, and even my own assessment and plan was for any given visit.  Each note should have an easily accessible visit summary (but not at the bottom of 5 pages of droll historical data I already know because I sent them the patient in the first place!).
  2. Allow coding gibberish to be hidden.
    Related to #1 would be the ability to hide as much “fluff” in notes as possible.  I only care about the review of systems and a repetition of past histories 1 out of 100 times.  Most of the time I am only interested in the history of the present illness, pertinent physical findings, and the plan generated from any given encounter.  The rest of the note (which is about 75% of the words used) should be hidden, accessed only if needed.  It is only input into the note for billing purposes. 

  3. Require all ancillary reports to be available to the patient.
    Patients are already the information interface between providers, so why not use them as our interface?  Why not have them able to give the ER doc permission to see recent labs, or give the specialists access to their x-ray reports?  Why do I have to get permission from them to get the information sent to me from the lab or the radiologist?  The patient is there in the room, so why can’t they just say, “Here are my results.  You can look at them.”  While they are showing me them I can explain how I interpret them.
  4. Require integration with a comprehensive and unified patient calendar.
    We have the technology to give each patient a comprehensive care calendar to look toward the future and into the past as to what tests are due and what was done.  When I order a test and get the results back (thyroid tests for example) I should be able to queue up the next test on a calendar that the patient can see and use.  This is the “GPS” idea I’ve had in the past, and  would be simple to even share between providers.
  5. Put most of the chart in the hands of the patient.
    Patient information, such as family history, medication list, social history (where they work, are they married, etc), and even a list of past surgeries should be managed by the person who knows it best: the patient.  Keeping track of this is next to impossible in a busy practice (especially for pediatrics), and is re-transcribed for every visit the patient makes to a new provider.  This is burdensome on everyone and leads to significant inaccuracies that would be easily fixed if a unified patient record centered on one managed by the one with the most to gain from its accuracy.
  6. Pay for e-visits and make them simple for all involved.
    One of the worst parts of my practice is that I must force patients to come to see me so I can be paid for the care I give.  This is especially unfortunate because the Internet allows easy communication, making many (if not most) of these visits unnecessary.   It is a waste of my time, it wastes lots of patient time, and it greatly increases absenteeism from work.  Yet I need to be paid for my services, as I am taking significant risk and using my training for their benefit.  The technology would make this easy, but the reimbursement model stands in the way.  CMS would have to do the changes to make this happen, but doing so would give a huge yield to doctors, patients, and employers.
  7. Allow e-prescription of all controlled drugs.
    This falls under the “duh” category.  Why is it safer to hand a physical copy of a controlled drug prescription to a patient than to send it electronically?  Is it safer to hand a person a check and have them bring it to the bank, or to send it electronically for deposit?  Come on, folks, this is just so obvious.
  8. Require patients’ records to be easily searchable.
    I spend huge amounts of time searching for answers to questions like: “were they ever on drug x,” or “when was their last y procedure?”  I would love to be able to do a ctrl-f (or cmd-f) search on patients charts to get that information.  It should be standard in all EMR’s to allow this, as we all spend way too much time searching, and probably order unnecessary tests because it’s just too dang hard to search.
  9. Standardize database nomenclature and decentralize it.
    Let’s stop the proprietary nonsense.  EMR products should be able to interact well with each other, retrieving information about the patient at various settings.  I personally don’t think the centralized database is the best approach, as it is far more risky to have all data in one location.  Just have each EMR able to go (with patient permission) and get information wherever it is.  I shouldn’t have to store the CBC results in my record; I should just have easy access to the lab’s records.  This has actually been done to a smaller extent with e-prescribing, which can give a unified view into the patient’s prescription history (which is often useful, although it is still quite slow).  Having data in proprietary silos is a foolish and inefficient storage method.
  10. Outlaw faxing.
    I hate faxes, and with the Internet enabled communication (like you reading this), faxes should not be needed.  They are difficult to transcribe to digital format, usually ending up as PDF files instead of searchable data.   Most faxed medical information (ironically) starts in digital format (word documents, etc), and then is converted to paper or PDF, only to be re-imported as non-searchable image files.  This is stupid, but it is so easy that the only way to prevent it is to not allow it.

So there’s my dream “meaningful use” list.  I would be interested to hear what other ideas you all have.

Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at More Musings (of a Distractible Kind)where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player.  He is a primary care physician.

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Coy Mitrani
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Rose McClean
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Rose McClean

Great analysis! I especially appreciate how thoughtful you were about involving the patient in the EMR conversation. This conversation is very critical for EMR success and should be further explored. You incorporated excellent ideas for other professionals to follow in order to enhance the benefits of EMR for patients as well as physicians. This article provides a great foundation in creating meaningful EMR programs and its powerful impact it can serve in the Healthcare industry.

Jon Kotila
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Jon Kotila

I feel that patients suffer while doctors are busy at their computers. There is little eye contact and the patient is left feeling that they are treating the computer rather than the patient. While I”m sure EMRs and EHRs have their value, I just wish doctors, and others, would spend more time making eye contact so that they might see what the patient’s body language happens to be. I also feel that EMRs cause a very impersonal relationship between patient and doctor.

Sean
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Sean

I also implement EHR systems and I am currently working on a major project within New York City. I think one of the largest issues right now is the sheer number of EMR vendors on the market. Each one of these vendors differs in structure, features, documentation methods, templates/defaults, and methods of communication. Beyond the above issues, there is the far more significant problem as to how the data is stored within these different systems. It’s all well and good that an EMR may meet HL7 and CCHIT requirements, but data transmission depends upon whether it is “structured” or “non-structured”… Read more »

Syed Hussain, MD
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Syed Hussain, MD

Well then but, there is differences of opinion but let me weight in: These devices called EMR are terribly and meaningfully useless when it comes to patient care that the patient needs. They are meaningful to the Feds who have no ideas about patient care.

southern doc
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southern doc

It doesn’t matter how good the system (designed by physician, engineer, and administrator) is if government and insurance bureaucrats require that it be used for meaningless chores.

Lindsay
Guest
Lindsay

I am an EMR implementor and have worked with a number of clinicians feeling the same way you do. Your list makes some great points! I can tell you that there are good products out there that accomplish many of your requests. The product I support happens to solve #s 1, 2 and 8, and integrates with a Patient Portal that accomplishes #s 3 and 5. I love suggestion 4, and think it would be a great way to manage patients! The system I support it webbased so the ctrl+F funciton does work, I utilize it a lot to wade… Read more »

CurtW, MD
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CurtW, MD

Nice list and great discussion. ‘am waiting for CPOE to be half as good as ordering something at Amazon. But, I digress… Yes, the doc, software engineer, and ‘bean counter’ triad is essential to assembling a useable product; but, the end user (doc) has too little time to invest in harnessing the knowledge and abilities of the other two and be the leader(s) of the software design project. For the impassioned, let me offer the following resources: 1. The American Medical Informatics Association: http://www.amia.org – interested docs can take one of the 10 x 10 courses to see if a… Read more »

tim
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tim

Doctors telling everyone else how to do their work would be funny if it were one exponent less ironic. I know: if doctors only managed the hospitals, then hospitals would be better. If doctors only designed software, then software would be better. You also tell your accountants how to account, and your lawyers why they’re wrong. We get it. I say this with love in my heart: you have a serious blindspot in your profession, which is why your profession is being taken away from you. (Not a good thing.) Try fixing the fragmentation of care and lack of communication… Read more »

Rob
Guest

Gosh, I wonder why you have trouble getting along with physicians…. If you use this kind of charm, it would seem you would be irresistible. I have worked with EMR for the past 16 years, having shaped it in my clinical practice, becoming one of the most successful implementations, recognized by HIMSS and others for my practical approach to use. I’ve been a featured speaker for the CDC on the subject as well. The reality is that a combination of physicians, engineers, and office administrators (considering the clinical, technical, and business sides of the formula) working together is the ideal.… Read more »

southern doc
Guest
southern doc

“Where are your professional societies?”

In bed with CMS and the large insurers, enjoying a post-coital smoke.

Craig "Quack" Vickstrom, M.D.
Guest
Craig "Quack" Vickstrom, M.D.

LMAO!!!

Margalit Gur-Arie
Guest

This is what happens when casual readers of Popular Mechanics are empowered to write the specs and instructions for pneumatic torque wrenches.
Where are your professional societies?

Rob
Guest

The problem is actually similar to that mentioned in the previous post (on political posturing). Societies could have solved this problem long ago and taken the lead, but (especially groups like the AMA) were too focused on status quo and not in leading substantial change. It is quite frustrating for me that our societies have been followers, not leaders. On the good side of things, these posts I have written have not gone unnoticed by ONC, the ones in charge of MU. I do believe that there are people there who understand the reality of the doctor’s office. I am… Read more »

Nick
Guest

Very good write up, being in the health field myself, it’s great to read such good content