Why touchscreen computers are the future for electronic medical records

As I explore the latest EMR offerings, and read all the blogs and media releases for and against EMRs, I am forced to wonder, “Has anybody ever asked us doctors what we either want or need?”

Too often it seems the requirements of EMR’s are more suited to organizations, systems, and number-crunchers than to either doctors or our patients. I understand that the data is important, but why should the adaptation should be more difficult than conventional paper-based records for those doing the majority of the work?

So here is my humble wish list for the EMR that I really want to see – my imaginary “DREAMeMR”

1. DREAMeMR should enhance all administrative and data aspects of my practice, i.e. enable me to work faster and more effectively. A system that will write letters for me, create statistics, facilitate prescriptions, book investigations and call my patients back when either they or I have overlooked an appointment, without me having to do more than I am already doing. I am happy that all this data will enable other agencies to manage healthcare in a better manner, but don’t expect me to have to work harder to do it for them.

2. DREAMeMR must enhance my patient contact, not detract from it. I want to be able to maintain eye contact with my patient as I enter data – not to have to focus on my keyboard or screen while I type data into fields.

3. DREAMeMR must have an intelligent database that I can use – if I have forgotten the latest TNM staging of pharyngeal cancer, my EMR should be able to remind me. If I need a drug dosage, the EMR should be able to comply.

4. DREAMeMR should enable me to think and communicate more, and be able to record data more easily.

This sounds like a tall order, but I really don’t think it is. Why not hold onto what is familiar to all practitioners – the pen and paper system – but in a modern form, by using touchscreen technology?

A digital pen and paper system has freedom far beyond that of the conventional keyboard. Most doctors can write without paying direct concentration to the process – not so with typing.

I envision a touchscreen system where the stylus takes the place of a mouse, using handwriting recognition, where checking boxes can open new dialogues, recording data seamlessly and accurately, where a drawing can be included into the record. The possibilities are endless. The technology is here.

A move from pen and paper to touchscreen and stylus should prove far easier that that demanded by many EMRs already in existence. And for many of those, perhaps all that is needed is to develop a new interface?

With the surge of interest in touchscreen technology, like the upcoming Apple “iSlate” and others, wouldn’t it be nice to have an touchscreen-based EMR ready when these computers become commonplace?

Martin Young is founder and CEO of ConsentCare.

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  • http://drgrumble.blogspot.com/ Dr Grumble

    You are so right. So far every new computer innovation I have encountered (with the exception of PACS and online results) has made things slower and more difficult rather than easier and quicker.

    Working with computers at the bedside is a particular problem. We are working with tablets with touch screens but they are not actually as easy to use as paper was. The nurses now enter their observations using PDAs.

    One possible solution for medical records is to write on material called paper and scan it in. Modern scanners can do this in an instant. Unfortunately that probably won’t meet the needs of the people collecting the stats who want boxes ticked. And we are yet to see the other benefits you rightly demand.

  • Anna

    It’s ludicrous to expect a computer to be able to read handwriting that most humans can’t. Being able to type and maintain eye contact at the same time is no more a “specialized” skill than being able to write with pen and paper. While the skills may not be specialized, they are necessary to the practice of many professions, including medicine. Those who lack these basic life skills should acquire them before attempting to enter a learned profession.

  • http://jerryfahrni.com J Fahrni

    Thanks for the great post. You’ve identified the biggest issue with the current development strategy for most healthcare technology designed today; no one is asking the practitioner how to make it better. The individuals using the systems are often the ones with the greatest insight into how to improve the system. Even though I work as a pharmacist, I see the same thing in my field. Our systems are ‘advancing’, but are in no way becoming more efficient, simplified, or standardized.

    I’ve been a big fan of touchscreen technology for quite some time and believe, like you, that it could be a significant game changer in healthcare. I also like the idea of continuing to develop the use of pen & paper into something digital. Technologies like Shareable Ink (http://shareableink.com/) and Satori Labs (http://www.satorilabs.com/) have the right idea by using pen & paper to create digitized records. This might be the solution to a nice transitional stage for physicians as they move forward into a fully electronic/digital system.

    Thanks again for thought provoking post.

  • Frank2941

    The poster is looking for a perfect system, and like in all areas (the practice of medicine being a great example), we cannot reasonably expect perfection.

    BUT, we can expect (and should demand) a lot.

    Those designing the system should have a very intimate working relationship with the users. In this case, that means much more than just the physicians. It also includes, nurses, technicians, receptionists, telephone answerers, pharmacists, billing office personnel, etc. (and that “etc” includes a lot of people).

    It is not an easy job to do this, but it is essential if they will be successful. The challenges are great, but the benefits are great. Like so many things that President Obama advocated when he was running for the office of President, it is must easier to advocate it that to do it.

  • http://www.consentcare.com Martin Young

    Anna, you make a valid point. But have you tried to type on something you are carrying on a ward round, single handed, while standing? Or on your lap? It just can’t be easily done, whereas we can write with great comfort and familiarity.

  • Classof65

    Generally the creation of software for medical records has been initiated by hospitals — and then it is left to the Purchasing Department to collect the specs from the appropriate affected departments for the companies developing the software. Depending upon which departments interact most with the software rep the better the system is for that department. Trying to adapt the hospital systems for use in doctors’ offices may put the emphasis on some areas and may not be the best system. Software companies, of course, want their system to serve everyone without many modifications so as to get the biggest bang for their employee programming time…

    I would get my fellow doctors together to take the time to write down clearly what they believe they need, just as you just did, and to send those requirements to several medical records software developers. Send the written requests in a large box — each doctor or pharmacist or nurse, etc.’s own list enclosed so as to make the most impact on the company bigwigs — in fact, address the box to the company CEO and indicate that you wish a reply from him/her and expect follow-up communication over time. Those of you who are willing to have a programmer come to spend some days with you to see what you really need should mention this willingness.

    As long as all you do is gripe among yourselves or on blogs, nothing will improve. Be squeaky wheels and you just might get some grease!

  • jsmith

    At my practice we are attempting to implement a “white board,” which tells the doctors and nurses where the pt is and what the pt needs (CXR room 1, etc). A piece of paper stamped with the pt’s name in the nurses’ to do basket worked much faster and with fewer errors. And a nurse would look at me while I was asking to her to perform an essential nursing task. Now she must finish her whiteboard keyboarding first. Why are we doing all this? Because the EHR vendor told the members of our clinic’s EHR committee that the whiteboard has worked in other places. Patent absurdity. Prediction: 10 years from now, it will be common knowledge among doctors and the public that the EHR revolution was a bust, resulting in increased costs, decreased doctor productivity and satisfaction, and no better quality of care. But the vendors will have hoovered up a lot of money.