EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Can EHRs evolve from minimally usable to delightfully indispensable?

Can EHRs evolve from minimally usable to delightfully indispensable? | EHR and Health IT Consulting | Scoop.it

Electronic health record platforms are among the most complex, interconnected, data-intensive software applications on the planet. Think about the seemingly endless fragments of patient information that an EHR is asked to store and maintain – basic demographics, diagnoses, chart notes, medications, allergies, upcoming appointments, previous surgeries and procedures, historical lab values, imaging studies, standing lab orders, e-prescription transmission transactions, claim submissions, and on and on.

 

Physicians and their staff also need to be able to review, transmit, reconcile, approve, and synthesize all of that clinical information to help make better, more informed decisions with their patients.

In 2008, fewer than 1 in 10 physicians were using an EHR, and the functionality that existed in those systems then would not qualify as a federally certified EHR product now. Over the last decade, to achieve federal certification, vendors worked at a feverish pace to add hundreds of features and change dozens more in order to achieve parity with the rest of the market. This transition from paper to digital happened so rapidly that usability suffered, innovation lagged, and real customer needs were under-prioritized.

 

Now that all certified EHRs share minimum functionality and can exchange information with each other, the time has come to refocus this entire industry on improving customer satisfaction.

The Office of the National Coordinator for Health IT has attempted to regulate the design of EHRs in a way that has not resulted in broad usability improvements to date. Approaching this immense problem from a more prescriptive regulatory perspective barely scratches the surface of what customers are demanding. While there should be required minimum standards for any software that is utilized by medical professionals to help them manage something as critical as patient health, no regulatory framework for usability will lead to more delightful user experiences for medical professionals or their patients.

 

What technology is needed in a modern medical practice?
Most complaints from EHR users stem from the feeling that the computer interferes with the ability of physicians to provide great, human-centered care for their patients. Many user interfaces look like they are 10 to 15 years old (because they are) and fail to meet customer expectations for how a modern application should function. Alert fatigue, infrequent software upgrades, and inefficient workflows contribute to this general dissatisfaction. In a recent study, researchers found that physicians spend 3 times the amount of time with computers as they do with their patients during a typical day. It's no wonder that EHR usability is consistently rated poorly across most software vendors.

Physicians and their staffs ultimately need software that supports their practice throughout the entire patient journey. Technology vendors must completely rethink their offerings by applying the essential components of user-centered design that have worked well in other industries.

 

Implementing an intentional approach to usable software
Usable software applications are intuitive, easy to learn, and memorable. They also must be efficient and prevent errors, all while deeply satisfying their users.

To achieve these six goals in health software, vendors must first gain a deep understanding of how a physician's office works – from the beginning of the day until the lights are turned off. A team of user researchers dedicated to this scientific task, investigating directly in doctors' offices, is crucial.

Tip: Merely dropping in for a few hours of office time is insufficient.  

Shifting to a user-centric approach in EHR design also requires gathering as much information as possible about how technology can assist customers with common tasks and data-intensive decisions.

Tip: It helps immensely to have a central place on the web where customers can request features. Often, the conversation that occurs in the comments section is crucial for software development teams to smartly refine feature requirements and improve usability.

Executives of EHR companies must embrace and encourage iterative software development within their product and engineering teams, with customer feedback directly informing each iteration.

Tip: Pair "minimum viable product" software development methodologies with user experience personas to turn users into happy evangelizers of products they love using every day.

 

Achieving indispensable EHR technology
For decades, physicians have pleaded with software makers to build functionality that helps them make better treatment decisions and provide better care for their patients. EHR vendors have instead delivered technology that is minimally usable and slows down the practice of medicine. Fortunately, this is not how it has to be.

As the entire healthcare industry transitions its business model from fee-for-service to value-based care, modern medical practices will find themselves relying even more on healthcare technology that efficiently collects, reports on, and synthesizes clinical data. To truly capitalize on this opportunity for smarter decision-making that leads to improved patient outcomes, current basic EHRs must evolve into mature, highly usable, indispensable tools that physicians and their staff enjoy using.

Technical Dr. Inc.'s insight:
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inquiry@technicaldr.com or 877-910-0004
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Why Can’t someone Give Me the Perfect Managed Personal Health Record (mPHR)?

Why Can’t someone Give Me the Perfect Managed Personal Health Record (mPHR)? | EHR and Health IT Consulting | Scoop.it

I’m not as scared of dying as I am of growing old, Ben Harper, Glory and Consequence

Whether we admit it or not, most of us are afraid of growing old.  There is a sense of loss, of youth and vigor, coupled with the burden of managing your health in relative isolation.  Although as a country we would like to think that we are each responsible for our own care, most of us as individuals would prefer for someone to be there, helping us through our time of need.  Years ago when I was advising one of the Presidential hopefuls regarding a healthcare platform,  I suggested that the campaign should be propose that individual was responsible for their own health, but as a country we would partner to provide the tools for the individual to succeed.  Now, almost a decade later, we are not much closer to this goal.

Personal Health Records (PHR) were thought to be the answer.  These records differ from more traditional EMR in that they are owned by the patient and aggregate information from multiple sources to give a complete picture of the patient.  For example, they might include clinic visits from multiple providers, hospitalizations and updates on an exercise program.  Literally billions were spent on PHRs by the likes of Microsoft (HealthVault) and Google.  Both efforts were failures with thousands (in the single digits) rather than the expected millions of enrollees.  As noted by David Shaywitz, healthcare is a negative good, something viewed more with resentment than in anyway positive.  And that extends to things that keep us healthy.  To interact with your health means you are imperfect, you are mortality.


Rather than a PHR, I would like to propose a different tool, a managed PHR (mPHR).  This would be owned by the patient, but managed by a surrogate, a care coordinator (CC).  This person would be responsible to keep the person on track, taking their medications, keeping their appointments, explaining their illness (or at least research) their problem.  This may seem far fetched, by I believe CC will be a new job in 3-5 years.  And when this army of providers spreads across the land, they’ll look for a tool to do their work.  And it won’t be an EMR.  It will be a mPHR.

What would the perfect mPHR do?

Here is a list I’ve compiled


  • Upload data from disparate hospitals and clinics
  • It would store and view previous radiology exams
  • It would do med reconciliation and education
  • It would send reminders
  • It would manage exercise programs
  • It would allow differing levels of permissions and access…for the patient, the advocate and family
  • It would message those defined in the persons ecosystem if the PHR identifies a down trend.
  • It would report on utilization and changes in utilization
  • It would collect biometrics including wt, BP but also depression and pain indices with reporting and messaging
  • It would link/suggest support groups based on the problem list
  • It would leverage secure texting and email for messaging
  • It would be platform agnostic & cloud based

The critical thing here is actually not the functional requirements…these have already been fairly well defined…it is the ability to easily work with surrogates and family while maintaining some level of choice and control by the patient.

This is not an idle ask.  I am now working with a developer building senior communities with integrated care and care coordination.  I can buy an EMR, but not an effective PHR for these communities.  With any luck at all, we will be managing thousands of lives in these communities in the next few years.

To all you bright entrepreneurs out there, help me out.  Build the perfect mPHR.  If I am right, and there is a lot of evidence I am, you’ll transform how we care for one another, and make a lot of money doing it.  I won’t be your only customer.


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