Provocative piece by hospitalist el jefe Bob Wachter. He laments how archaic most electronic records are, and I agree:
You’d think that medicine’s conversion from paper to electronic records would solve many of these problems, but ““ to date ““ all it has done is create new-fangled electronic silos. In most EMRs, including the GE system we’re using at UCSF, the notes are really just electronic incarnations of what previously lived on dead trees ““ no more likely to facilitate collaboration than the paper records they replace.
In many cases, they spew out template-driven notes that are long on noise and contain very little useful information. Very little power of the electronic medium is being harnessed.
On the other hand, Web 2.0 sites, like Facebook, provide intuitive tools that enhance collaboration and social communication:
How great would it be if, through the medical record, I could interact with multiple specialists who have seen my patient ““ in real time, just like my kids are interacting with far-flung friends on Facebook. And if nurses could leave me a note which I could answer online without having to respond to a page. And if the daily plan for a patient ““ developed collaboratively ““ could be shared among all the caregivers, with notes appended when a patient’s clinical ship seemed to be blowing off course.
One problem is that much of health information technology is staffed and programmed by has-beens. There is very little innovation, with most of forward-thinking ideas confined to sites like Google, Facebook, and MySpace.
It would be nice if an electronic record was designed with the singular focus being the end-user experience. They should make physician’s lives immeasurably easier, and significantly decrease the time spent charting and tracking patients.
There are very few record systems that meet even this minimal standard.
An EMR like Facebook? We can only wish.
Related posts:
- Op-ed: Why doctors still balk at electronic medical records
- Will the benefits of digital medical records only be seen in large, integrated health systems?
- Most hospitals still use paper records, and why money alone won’t solve the electronic medical record problem
- Medical students who are used to electronic records
- Electronic medical records and the iPhone
- How an EMR destroyed this practice’s medical records
- The unintended consequences of electronic records
{ 2 comments }
All mentioned are very valid points and I don’t blame physicians for the frustration one bit for the areas of discontent. I know I wrote a full EMR a few years ago just out of the fact that my client didn’t like or felt he could not use anything that was out there. I stopped writing though as it became too large of a project for one person to keep up with and maintain as the pace of technology has picked up tremendously. That’s why you see me hanging around the blogosphere as having been on the back side directly working with physicians to create solutions, so I can understand everyone’ frustration and mine too! Even though I don’t continue to write I still have that tremendous insight though on how it needs to work and keep the “clicks” down to a minimum as that was probably one of the most common complaints of all, no matter what EMR or EHR was being used and it’s still echoed out there today, alive and well.
New programming technologies hopefully will bring this to practice in the physician’s office one day, one in particular is Silverlight from Microsoft. This is not meant to be a commercial by any means, but it is evolving and I have sat in many programming meetings at Microsoft and had conversations with other developers and there are many of the answers in this technology, but it’s not quite there yet.
I did a couple posts on the subject after attending HIMMS this year and did a video on the common user interface under construction by the NHS in the UK. That project is open for developers to contribute to as well. It may not be what we end up with here, but it’s one good start, and as other great ideas come to the table, it will get better.
I have worked a little with the technology too and am very impressed. Drag and drop, like Facebook, yes! Just what the doctor ordered:)
There is no reason why we need to have so many different interfaces whereby each hospital, each office is a huge learning curve and through the integration process of having web based products, slowly, and I do mean slowly, things are coming to light here. I speak honestly and try to tell it like it is.
It is hard enough seeing the number of patients today required to keep the doors open as time is tight by all means, and to worry about a complicated record system is something that doesn’t fit the picture well at all.
I’ll give you a couple links here where you can take a look and see what’s coming up on the agenda and perhaps this will at least give some feeling of relief. I think this year at the HIMMS convention the feeling was the same from all, everybody get on the same boat, but how that all comes down remains to be seen:) I did the one video live on my tablet, so that was really someone poking around the demo and not orchestrated to look “perfect”.
http://ducknetweb.blogspot.com/2008/05/microsoft-common-user-interface-for.html
http://ducknetweb.blogspot.com/2008/06/possibility-of-national-electronic.html
Anyway, I hope this will perhaps shed some positives out there to know there is light at the end of the hall. The user interface along with interoperability to exchange between systems are the name of the game.
And not to beat a dead horse, but if/when the feds get involved in EMRs (as both candidates seem to like to mention), you can be assured that it will be as un-Facebook-like in its ease and functionality as you can possibly imagine.
Facebook is successful (makes money?) b/c of the number of eyeballs it gets. Companies that create EMR databases and interfaces, similar to what SAP might implement for resource management, make money by selling support. You can’t sell support if the software is 1) easy to use and 2) easy to update. Thus, you have incentive to make the code and interface onerous.
On a related note, I’m certain in saying that EMR alone won’t make great improvements to healthcare quality. The same number of mistakes will happen – they’ll just be automated. This is the same effect caused by MRP software in manufacturing. If the process doesn’t work without the software, the software will make the process work incorrectly more quickly.
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