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Saturday, March 8, 2014

Electronic Medical Records, Still problemmatic for Providers

Altlhough we have witnessed the growth of EMR acquisition an overwhelming number of remain skeptical.  Many plan to dispose of their current EMR and invest in new systems.

Medical practitioners are basically applied practical scientists, and have relied on science based on ‘big data’ derived from clinical trials and peer reviewed data accumulated over many years. It is therefore somewhat of an enigma why they would be unhappy with elctronic medical records which surely has the capability of reliably gathering and recording data and also the availabilty for analytics.

The installed base by fait accompli has established an infrastructure which could be compared to  vs DSL as compared fiber-optic internet This was encouraged largely by federal incentives and a rush to establish a national network.  The aspects of interoperability were then layered upon the electronic medical record, and also “meaningful use’ which is a misnomer since it has nothing to do with meaningful use on the provider side of the equation.  Meaningful functionality was neglected in encouragement of  ‘the adoption of EMRs.  Caution was advised over a decade ago that the current generation and versions of electronic health records was ill suited to the task.  

1. Our study ten years ago revealed that the human-interface was ill-suited to patient-provider interaction. This due to the discontinuity between face-to-face interaction in a patient and provider encounter and the unfriendly user interface

2. The data entry in the form of clinical history, and physical examination input is not in the structure that physicians use in conventional medical written medical records. This creates more distraction and loss of efficiency as the provider struggles to be accurate in recording a clincal encounter.  Some EHRs force the provider to enter some date prior to moving along to the next step. After some time Providers  familiarize themselves with the routine flow, however many times there may be an entry or section with which the provider is not familiar.   These systems were not designed in an era of user friendly, nor intuitive navigation in the Electronic Health Record. Graphic User Interfaces (GUI) are almost unknown in most EHRs.

3. Medical Economics published a recent survey of providers revealing the significant majority of MDs (75%) who are very dissatisfied with their present electronic medical record.  And now many plan to replace their current system. 45% of 967 respondents to the survey indicated patient care is worse with EHR devices, and 67% said their investment was not worthwhile.

The good news is that the IT industry is eager to profit from this revolution of Health Information Technology. The Industry has a specialized organization known as the Health Information Society, also known as “HIMSS”. The group has a collection of IT, health consultants, physicians, hospital administrators (CIOs, CTOs) and others who collectively work together to advise the industry, vendors, and software developers about what is needed by health providers and data analystis.

Black Book ranked EHR providers for 2014 scoring vendors across six different client experience categories.

EHNAC and WEDI will certify an assurance of quality and functionality of software for providers..The goal is to enhance usability for providers. This is a step in the right direction.


In late February 2014 the Institute on Medicine’ Roundtable on Value and Science Driven Health Care published a discussion paper on Return on Information….a standard model for assessing institutional return on investments for electronic health records.

The formation of accountable care organizations presents many challenges, and many needs for information technology to synthesize patient care across a continuum.

Measurements and a standard model are needed to compare different institutional experiences implementing different technologies and approaches for accountable care organizations.

While the emerging roles of  patient, family and public participation are acclaimed to be a necessary componet for improved health the IOM discussed the changes as possibly disruptive innovations on affordability, quality and outcomes in health and health care.


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