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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Measure Your Medical Practice Staff Tech Skills

Measure Your Medical Practice Staff Tech Skills | EHR and Health IT Consulting | Scoop.it

Before you begin training staff to use a new EHR or practice management system, it's a good idea to assess their overall comfort level and experience with using technology. Staff members with low computer literacy should receive basic skills training so they can take full advantage of vendor training during implementation. Without that foundation, they may feel lost and never achieve true proficiency with the new system, experts say. Here is a basic skills assessment survey recommended by CMS. Employees are instructed to indicate how familiar they are with various tasks or skills on a scale from 1 (no experience) to 5 (very comfortable).


Desktop skills:

• Safely turn computer on and off

• Restart your computer if it becomes locked

• Open a program using the Start menu

• Name the basic computer system parts

• Explain the terms: icon, menu, window, click, select, drag

• Use scroll bars and move, resize, and close windows

• Use help screens in the software programs

• Navigate among folders, create, name, and delete folders

• Copy or move a file from one folder to another

• Cut or copy and paste text


Internet skills

• Use a Web browser

• Recognize a URL

• Explain the terms ISP, website, home page, search engine

• Type a URL in an open box

• Use back and forward buttons to move through Web pages

• Create a bookmark

• Locate and click on links

• Use a search engine

• Print a Web page

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Tech Tools to Boost Patient Collections

Tech Tools to Boost Patient Collections | EHR and Health IT Consulting | Scoop.it

With the proliferation of high-deductible health plans under the Affordable Care Act, patient payments have become a bigger chunk of many practices' revenue. As a result, experts say physicians should be developing more sophisticated collection strategies that take advantage of technology to help get money in the door.

Used effectively, technology can help smaller practices stay on top of patients' coverage and financial responsibilities under the new high-deductible plans, as they may be new to both practice and patient. Many newly insured patients are unaware of the service-level details of their policies. So it's important to give your staff readily available information about coverage, balances, and answers to frequently asked questions.

Technology can help you streamline processes at the front desk to facilitate collection at time of service, provided that you invest in staff training, said Colleen Fusetti, a director at FluidEdge Consulting in Malvern, Pa.

"You need to put a lot of emphasis on training staff to use the technology and understand patient balances and payment options so that they, in turn, can educate the patient," she said. "The ability to collect drops considerably after the patient walks away from the front desk."

Fusetti and other revenue cycle management experts also offered these tips for getting the most out of your technology tools to improve patient collections:

• Set up a patient portal. The portal allows patients to check their eligibility and claims data and view or pay their balances online.

• Integrate an insurance eligibility service into your practice management and EHR systems. Some services allow you to run a verification check on every patient scheduled for a visit over the next few days so that you can reach out to patients in advance to get new insurance information, if needed.

• Use an automated appointment reminder service. The services not only remind patients about upcoming appointments but also link patients to the portal where they can see any pending balances, make payments, and review their coverage before arriving.

• Consider online credit card processing. You can accept credit or debit card payments from any Internet-enabled device linked to a mobile card swiper.

• Set up automatic payments. Many merchant service companies offer an option to keep patients' credit card information on file securely. After discussing financial responsibility for a future procedure or service, patients can decide whether to authorize a one-time payment pending final calculation of their bill or set up a payment plan with recurring payments.

• Take advantage of online resources. The AMA offers a Point-of-Care Pricing Toolkit free to its members. The resource provides tools to help practices collect what patients owe at the time of service.


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Keeping Up With Technology: A Must for Medical Practices

Keeping Up With Technology: A Must for Medical Practices | EHR and Health IT Consulting | Scoop.it

Still carrying around that BlackBerry you've had for the last five years? Still using Microsoft 2003 on that XP machine of yours? Still think the "cloud" is a fad? You might be doing yourself and your business a disservice if you answered "yes" to one or more of those questions.

Keeping up with the ever-changing world of technology is tough. Change can be hard. It's much easier to keep the status quo and ignore all the technological advances happening around you. The problem is, if you don't adapt and keep up with technology, you'll miss out on all the advancements and benefits it has to offer.

That trusty BlackBerry took too long to embrace touch-screen technology and missed out on creating a robust app store. The result is you can't check into your American Airlines flight on your phone, you can't use Hailo to get a cab, you can't access your Google Drive documents, and you can forget about looking up restaurant reviews on Yelp. Basically, even though switching to an Android or iOS device may be inconvenient in the short-run, the long-term benefits are well worth it. You'll have to learn how to use a new tool but that took has far more uses.

Technology in the workplace can mean the difference between a successful business and a failing business. Capable hardware and efficient software will keep your office running in tip-top condition and will allow your employees to focus on their jobs instead of troubleshooting their computers.

Look into Web-based programs that can be accessed remotely and that have export features that allow you to easily extract the data you need. Productivity suites like Google Documents are free and offer a comparable experience to the costly Microsoft Office standard (Google documents are compatible with MS Word). If you have to use Microsoft Office, don't skip on more than one major update. The difference between Word 2007 and Word 2010 is probably greater than you think.

The anxiety in introducing new technology to your office staff lies in the assumption that each employee has a different adoption threshold; some will "get it" and others will struggle. That's not as big of a hurdle as it's been in the past, as technology has become more uniform. Most people have a smartphone of some design, and many have households with smart TVs, multiple computers, and other universal technologies. Like all things, it may take a day or two for your staff to become comfortable with the new work flow, but your bottom line...and talent pool...will appreciate it.

In summary, don't be afraid to try new technology. If there's a hot new device or productivity program, there's probably a reason for it being so popular. Don't turn your practice into a technological ghost-town. Think about what your competition is doing.

In regards to technology, it’s good to be a leader and it’s also good to be a follower ... just make sure you’re one of them versus neither of them.


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Keeping Up With Technology: A Must for Medical Practices | Physicians Practice

Keeping Up With Technology: A Must for Medical Practices | Physicians Practice | EHR and Health IT Consulting | Scoop.it
Still carrying around that BlackBerry you've had for the last five years? Still using Microsoft 2003 on that XP machine of yours? Still think the "cloud" is a fad? You might be doing yourself and your business a disservice if you answered "yes" to one or more of those questions.

Keeping up with the ever-changing world of technology is tough. Change can be hard. It's much easier to keep the status quo and ignore all the technological advances happening around you. The problem is, if you don't adapt and keep up with technology, you'll miss out on all the advancements and benefits it has to offer.

That trusty BlackBerry took too long to embrace touch-screen technology and missed out on creating a robust app store. The result is you can't check into your American Airlines flight on your phone, you can't use Hailo to get a cab, you can't access your Google Drive documents, and you can forget about looking up restaurant reviews on Yelp. Basically, even though switching to an Android or iOS device may be inconvenient in the short-run, the long-term benefits are well worth it. You'll have to learn how to use a new tool but that took has far more uses.

Technology in the workplace can mean the difference between a successful business and a failing business. Capable hardware and efficient software will keep your office running in tip-top condition and will allow your employees to focus on their jobs instead of troubleshooting their computers.

Look into Web-based programs that can be accessed remotely and that have export features that allow you to easily extract the data you need. Productivity suites like Google Documents are free and offer a comparable experience to the costly Microsoft Office standard (Google documents are compatible with MS Word). If you have to use Microsoft Office, don't skip on more than one major update. The difference between Word 2007 and Word 2010 is probably greater than you think.

The anxiety in introducing new technology to your office staff lies in the assumption that each employee has a different adoption threshold; some will "get it" and others will struggle. That's not as big of a hurdle as it's been in the past, as technology has become more uniform. Most people have a smartphone of some design, and many have households with smart TVs, multiple computers, and other universal technologies. Like all things, it may take a day or two for your staff to become comfortable with the new work flow, but your bottom line...and talent pool...will appreciate it.

In summary, don't be afraid to try new technology. If there's a hot new device or productivity program, there's probably a reason for it being so popular. Don't turn your practice into a technological ghost-town. Think about what your competition is doing.

In regards to technology, it’s good to be a leader and it’s also good to be a follower ... just make sure you’re one of them versus neither of them.
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What’s the Difference Between CDI Programs and EHR Optimization? | Hospital EMR and EHR

What’s the Difference Between CDI Programs and EHR Optimization? | Hospital EMR and EHR | EHR and Health IT Consulting | Scoop.it

I recently heard someone describe their EHR optimization as a Clinical Documentation Improvement (CDI) project. It made me start to wonder if CDI and EHR optimization were quickly becoming the same thing.

While some CDI programs require EHR optimization, not all CDI programs require it. Some EHR optimization can improve clinical documentation, but not all of them. However, there is a decent overlap between the two efforts.

There are a lot of ways a CDI program can improve your clinical documentation. As we start to see full adoption of EHR software, most of the CDI programs are going to focus on the way the visit is documented in the EHR. While the EHR use might be to blame in many cases, the most important part of any CDI effort is the people that use that program. In fact, it’s often not even about how they use the program, but just the choices they make.

What has become very valuable is that EHR’s have made CDI programs much more efficient. They can run the program remotely. They can run reports that focus on common clinical documentation errors and focus their program on those specific errors. Technology can really help a CDI program to focus on the pieces of the chart that matter most.

EHR optimization on the other hand could have nothing to do with improving the clinical documentation. It very well may be that the clinical documentation is perfect. In an EHR optimization, you may only be looking at how to improve the physician workflow while maintaining the high level of clinical documentation.

EHR optimization is a powerful thing and not enough organizations are doing it. I get that they’re too distracted by meaningful use, but if we’re going to really benefit from EHR software we need more organizations focused on optimizing their EHR use.

It will be interesting to see how hospital leadership handles the governance of CDI and EHR optimization programs. They are both going to be very important going forward.



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EHR Uncovers Drug Benefits

EHR Uncovers Drug Benefits | EHR and Health IT Consulting | Scoop.it

Diabetes drugs to treat cancer patients? Through EHR analysis, experts have discovered the diabetes drug metformin may be able to treat some types of cancer. The study, published in the Journal of the American Medical Informatics Association, predicts this type of analysis could be used to repurpose other drugs for unexpected treatments.

According to Health Data Management, Vanderbilt University Medical Center’s Josh Denny, M.D., associate professor of biomedical informatics and medicine, and Hua Xu, adjunct associate professor of biomedical informatics, as well as colleagues at Vanderbilt, Columbia University and the Mayo Clinic conducted the study.

Astonishingly, researchers reached the hypothesis that metformin may treat cancer through EHR analysis. iHealth Beat reports that researchers analyzed EHR records and tumor records to uncover this correlation. The drug was found to have an effect on certain cancers, including breast cancer, colorectal cancer, lung cancer, and prostate cancer.

“Our EHR allowed us to delve into details of treatment and response - cancer staging, control of cancer, the various timelines involved and cancer subtypes,” Denny said. “We’re now building on this study, pursuing opportunities for using our EHR to look at all drug exposures across a given disease - starting with cancer. We’re trying to find other signals that may look like metformin in terms of affecting patient outcomes.”

Researchers analyzed the patients' five-year survival rates when exposed and not exposed to metformin.

“Large EHRs are valuable sources for drug repurposing studies. Our findings validate the beneficial effects of metformin for cancer survival. Ongoing and future clinical trials of metformin for specific subtypes of cancer may lead to new opportunities for chemotherapy,” explain researchers. “This study serves as a model for using EHRs and informatics approaches to robustly and inexpensively validate drugs for repurposing.”



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Do Certified EHR Technology, Alerts Risk Patient Safety?

Do Certified EHR Technology, Alerts Risk Patient Safety? | EHR and Health IT Consulting | Scoop.it

After the HITECH Act was passed and the Medicare and Medicaid EHR Incentive Programs were established, healthcare providers began computerizing their patient records and adopting certified EHR technology in an effort to promote care. However, integrating electronic records into the physician workflow has led to a variety of issues, according to the Agency for Healthcare Research and Quality (AHRQ).


While certified EHR technology has been considered a surefire way to improve patient safety, there are many examples proving the opposite and finding that these health IT systems may lead to medical errors that threaten patients’ lives.


The majority of medical technologies – whether infusion pumps, cardiac monitoring devices, or certified EHR technology – have warnings that tell physicians when an action is unsafe for the patient. Through these alerts, clinicians are expected to stop a prescription or a medical procedure deemed dangerous for a particular patient. In particular, some important alerts are meant to notify a doctor whether a patient will have an allergy or negative drug reaction.


However, the widespread computerization throughout the clinical setting has brought an enormous number of alerts among different medical devices, which physicians manage every day. A study conducted last year shows that monitoring devices across 66 patient beds in an academic hospital generated at least 2 million alerts throughout a single month.


In another study surrounding ambulatory care, computerized provider order entry (CPOE) systems generated alerts for as much as 6 percent of all orders entered, which means doctors dealt with dozens of warnings per day.


When it comes to managing these large amounts of warnings, many clinicians experience alert fatigue and become desensitized to the safety alerts. This could be a major problem for the healthcare sector, as physicians may ignore some warnings due to alert fatigue and cause serious medical errors within the clinical setting. The results show that many physicians override most CPOE warnings.


With more exposure to these warnings and additional use of health IT systems, physicians become even more prone to alert fatigue. This problem is also due to the mere fact that many of these alerts generated via CPOE systems are often “clinically inconsequential,” AHRQ reports. The problem with ignoring certain alerts that do not pose harm is that clinicians will also bypass any warnings that could lead to a serious safety issue for a patient.


Essentially, alert fatigue and the high number of warnings may be leading to additional medical errors and patient safety issues throughout the healthcare industry. The widespread use of certified EHR technology may not have the intended consequences once hoped for with regard to quality care improvements.


In fact, a Boston Globe investigation from 2011 shows that alert fatigue and the failure to respond to critical warnings via medical devices led to more than 200 fatalities across a five-year period.


AHRQ gave some recommendations to prevent some of the issues associated with alert fatigue. Increasing alert specificity and eliminating inconsequential alerts, customizing alerts to each individual patient, providing tiers for alerts with regard to severity, and using human factors strategies when designing the warning systems may all lead to greater patient safety and a reduction in medical errors associated with alert fatigue.


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Five Mobile Health Tools for Practices to Consider

Five Mobile Health Tools for Practices to Consider | EHR and Health IT Consulting | Scoop.it

As technology evolves and medical practices attempt to get more patients actively involved and engaged in their healthcare, many practices are exploring how mobile devices might help them along that journey.

But with so many mobile device options available and with so little long-term evidence to show which tools are most effective and in what circumstances, it can be difficult to determine what mobile health solution is right for your practice.


Chanin Wendling, the director of the division of applied research and clinical Informatics at Geisinger Health System, is involved in determining what mobile and portal technologies drive digital patient engagement and facilitate the provider's ability to deliver quality patient care.


During her presentation, "Active Patient Engagement: mHealth as a Tool for Interaction," at the Healthcare Information and Management Systems Society (HIMSS) conference in Chicago, Wendling discussed some of the most notable mobile health options available to practices today. She also shared some of her feedback regarding which of these tools practices might want to consider and why.


1. Patient portals (that can be accessed via a mobile app or on a mobile device). Patient portals are a fundamental platform in helping patients become more informed about their healthcare, said Wendling. They also may be a great tool to help patient visits go more smoothly.

Wendling noted that Geisinger recently introduced a new pre-visit center patient portal feature to see if it helps streamline patient visits and help patients come to appointments more informed. Two weeks prior to appointments, patients receive a message that they should log on to the portal to fill out go pre-visit paperwork, review notes from previous visits, and so on.


2. Mobile apps. While mobile apps are generating a lot of buzz, practices may want to proceed cautiously before rushing to implement them. Wendling said that since there are so many options, and since many of them are "young," it can difficult to determine which are going to be valuable to your patients and healthcare system.

So what's a good place to start with mobile apps? If your healthcare system is using desktop-based applications and your vendor offers a fairly inexpensive mobile app, it's probably worthwhile to deploy that, said Wendling.


3. Text messages. Text messages have been an "underrated" mHealth tool, said Wendling. Since patients are already interested in and familiar with text messages, a text message program is cheap to deploy, and such a program can be implemented quickly, it's a great mHealth option for many health systems, said Wendling.

Examples of how Geisinger is using text messages include text message appointment reminders and text messages sent to diabetic patients hoping to lose weight that include motivational language and tips.


4. Activity trackers. Wendling was bit more cautious about mobile devices that track activity and health information that can then be shared with providers. "... I think the big issue there is, do you want the data?" she said, noting that it may add to physicians' workload.

While this type of mHealth has promise, carefully consider whether the approach you are considering is necessary and of clinical value to your patients. 


5. A multi-faceted tablet approach. Another mHealth tool that Wendling touched on is a variety of ways tablets might be used in patient care.

Geisinger, for instance, is embarking on a pilot program to test whether tablets distributed to in-house patients can entertain and serve as a positive distraction for pediatric patients, connect patients to medical information, enable patients to provide feedback to providers (such as their pain level), and so on.


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Three Tech Tools Your Practice Should Be Using, and Why

Three Tech Tools Your Practice Should Be Using, and Why | EHR and Health IT Consulting | Scoop.it

Physician-patient communication has never been more significant and critical for successful practice operations. Here’s why.

Patients today are well connected socially and electronically and have very high expectations — actually demands — for relevant, timely, and action-oriented responses from physicians and practices. On other side, physicians have more reasons to initiate communication with patients to be sure they are responsive, adherent, and moving their own healthcare needs along as directed.

Below are the three ways physicians should be using technology to better engage and communicate with their patients:


1. Patient Portals. Physicians often resist changes to their work processes and fear patients will be confused by the data pushed to them through a portal. However, looking at the benefits the patient portal offers, more practices are using patient portals as a resource. Through the portal, patients can view valuable and updated health information online and ask questions for immediate or later response. But also these portals can generate an increase in patient loyalty because practices are providing more context and information beyond what is said during the appointment.  When the portal demonstrates an “above and beyond” attitude by your practice, patients will respond favorably. Practices can utilize patient portals the most by including key features of open access scheduling, patient education, two-way messaging, and patient reported outcomes.


2. Video conferencing.  Video conferencing can be an incredibly effective tool in the employment of remote telemedicine. First, physicians and patients can reduce the costs associated with regular office visits. Second, video conferencing can have uses beyond the private practice by making physician-to-physician connections for consultations and referrals easier and faster. Video conferencing solutions can surely influence efficiency for healthcare providers by expanding their reach, providing quality care on-demand, and reducing costs.

  

3. EHR Platforms.  To meet requirements in the second stage of the government's EHR incentive program, at least 5 percent of a practice’s patients view, transmit, or download their personal health information. By implementing a certified EHR that has user-engaging patient portals, practices can also improve patient care and patient loyalty. Additionally, an EHR platform designed with a user-engaging patient portal, may offer a new experience for patients, especially if they can access information through properly secured mobile apps.

We have entered an era in which patients can easily access their medical records; and pay their bills, request appointments, research health topics, review personal health information, complete medical forms, and update their profiles and contact information online. That is, as long as practices embrace the technology that enables patients to do so.

Physician practices should be ready for the new age of patient communication because the speed at which patients desire and demand information has shifted from soon, to instantaneous.


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Drchrono uses Apple Touch ID to let doctors into electronic health record

Drchrono uses Apple Touch ID to let doctors into electronic health record | EHR and Health IT Consulting | Scoop.it

Apple opened up the Touch ID fingerprint reader to third-party developers when it released iOS 8, and some in the health care world are beginning to take advantage of it.

Drchrono, which makes an electronic health record optimized for use on iPads, has now used that capability to authenticate doctors into the patient record — and to keep unauthorized users out.

This may be part of a wider push by Apple to get iPhone 6s and iPads into the tech arsenals of enterprises like large medical groups and hospitals. The new iPad Air 2 and the iPad Mini 3 now come with Touch ID, as do the iPhone 5s, iPhone 6, and iPhone 6 Plus.

Where the medical record is concerned, the Touch ID button could be hugely effective in providing secure yet easy access. For care providers using drchrono, three taps will get them into the medical record. They rest their finger on Touch ID to get into the iPad, tap the drchrono EHR app, and then, when the app is open, they hit Touch ID once more to get into the EHR. They no longer have to enter a passcode.

“The amazing thing about Touch ID is that people sometimes forget password and PIN codes,” Drchrono COO and cofounder Daniel Kivatinos wrote on the company’s blog. “This changes the game even more … touch technology in health care.”


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Harnessing the Power of Big Data with Digital Health Partnerships -

Harnessing the Power of Big Data with Digital Health Partnerships - | EHR and Health IT Consulting | Scoop.it

In today’s digital world, electronic patient data is growing exponentially and moving faster than healthcare organizations can imagine. At the same time, clinicians suffer from information overload, and high-volume and increasingly complex clinical patient loads, alongside dwindling time and resources.

Now more than ever, the pressure is building to harness the power of big data and digital technologies to help clinicians make faster, patient-centric decisions that increase quality of care and enhance health outcomes all while decreasing costs.

Sounds great, right? Especially to the critical care domain where data is extraordinarily dense, time is our greatest opponent, and fiscal concerns represent an annual cost to the U.S. economy in excess of $260 billion and approximately 40 percent of total inpatient costs.

But what if health care analytics and clinical decision support (CDS) could combine to deliver rapid bedside diagnostics or upstream health detection capabilities? That is to say, a tool that provides first responders, clinicians, hospital staff, home care providers, and patients with clinically relevant, patient-centric information, intelligently filtered and presented at appropriate times to transform care delivery.

Historically, CDS applications have operated as components of comprehensive electronic health record (EHR) systems—in other words, retrospective data repositories or order entry systems with limited data streams that are, at best, semi-real time.

However, the next generation of CDS tools seeks to incorporate advanced data processing systems capable of discovering and harnessing actionable insights from all varieties of medical data, and leveraging these insights for diagnostic, predictive and prescriptive capabilities.

In a nutshell, this next gen CDS tool will aggregate disparate patient health information—static and real-time—across care delivery touchpoints for analysis and optimization, enabling clinicians to make faster decisions and implement personalized, patient-centric treatment options at the point of care, whether that is the home, ambulance, hospital or battlefield.

Bear in mind, this description simplifies what is a highly sophisticated and complex health IT tool to a functional concept. Key challenges for implementation include the ability to:

  • Collect and aggregate health data, including that from monitors, throughout the patient care continuum into a single portfolio
  • Normalize, pre-process and de-identify data for analysis—not all data is created equal and not all data is useful in its raw form
  • Capture data at the point of care, stream for real-time computational analysis and combine with retrospective data
  • Present actionable insights in a format that end-users can easily consume for enhanced decision-making in the clinical workflow or home life-flow

Ultimately, such a solution could have the power to save a life, elevate care delivery, reduce length of stay, improve quality of life or predict and avoid a critical health event altogether.

To many, this sounds almost like science fiction, but probable with the help of a small village—or in our case, a team of digital health partners comprised of world-class researchers like those at the University of Michigan, advanced analytic technology products, wearable and anti-wearable sensors, and mobile and connected health solutions.

Healthcare has lagged behind the retail and financial sectors in the use of big data and digital technologies but the gap is closing and closing fast. The risks are high, but manageable through the teaming of digital health partners, and worthy of such a high-impact payoff. Data is king and the more hard evidence we have the better decisions we can make as clinicians, patients, families, providers, payers and industry alike.



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EHRs Should Automate the Business of Medicine

EHRs Should Automate the Business of Medicine | EHR and Health IT Consulting | Scoop.it

EHRs should automate the business of medicine and eventually the science of medicine, while protecting the art of medicine. Margalit Gur-Arie shares her insights. 

By the time the next decade rolls in there will be no paper charts. There will probably still be paper floating around in various capacities, but there will be no one charting on paper. The term “charting” itself may become obsolete, like yonder or popinjay. The term EHR, which is what replaces the paper chart, won’t last either because it doesn’t roll easily off the tongue like say, email instead of letter or missive. EHRs don’t do anything else easily, so chances are EHRs themselves won’t last much longer, relatively speaking. Sooner or later, the national spotlight will shift to something other than health care, and other electronic critters will emerge from the shadows.  What will they be? What should they be? Those could be two very different answers.

What Should Be

Have you noticed how people advocating for EHRs use the word quickly in practically every sentence? Mega EHR allows you to quickly document XYZ, and Super EHR can quickly gather all historical data and display it in a summary dashboard which allows you to quickly assess the status of the patient. You can quickly send prescriptions to pharmacies, quickly order a bunch of tests, and quickly print out (the horror!) education materials. Your staff can quickly schedule patients, quickly answer questions, quickly verify eligibility and quickly drop claims. Your patients can quickly get answers, quickly schedule visits and quickly have their concerns resolved.

Of course, most of these things are aspirational at this point, but the language is indicative of the thought process behind EHR design: hurry up and get it over with. Time is money and quickly disposing of each patient is absolutely imperative in a high functioning health system. You could argue that there is nothing wrong with speeding up, or even eliminating, administrative tasks, and you would be right. But is reviewing historical information on a patient and documenting today’s encounter an administrative task? When reviewing histories is compressed into briefly glancing at a bunch of sparklines like they have for the stock market, it may seem like you are engaging in an administrative task. Buried somewhere deep in the dark chart though, there may be a note you made about Mary’s difficulties to navigate the front porch stairs last year.

Why did you make that old note? It’s not required for billing. It’s not demanded by insurers. What made you type that in? Do you usually make notes about irrelevant things that you fully expect to never see again? When you used paper charts, you had to flip through many pages to gather the information you can now quickly glean from your infographic patient dashboard. And while you were paging back and forth through that chart, chances are you would have stumbled upon that little note that seemed important enough for you to scribble down last year. And maybe you would discover other little notes too.

Is reading a book the same as reading the SparkNotes? Oh, you will pass the test either way, and may even get better scores with the SparkNotes version, but is it the same? Is reading this: “Ultimately, he is unable to bear the psychic consequences of his atrocities”, the same as reading this: “Tomorrow, and tomorrow, and tomorrow, /Creeps in this petty pace from day to day, /To the last syllable of recorded time; /And all our yesterdays have lighted fools /The way to dusty death. Out, out, brief candle! /Life’s but a walking shadow, a poor player, /That struts and frets his hour upon the stage, /And then is heard no more. It is a tale /Told by an idiot, full of sound and fury, /Signifying nothing.”? Which version leaves you better equipped to address the story at hand, and the story-teller himself as a whole person? And which version makes you, the reader, feel more like a whole person?

Whatever else the EHR of the future might do, it should quit trying to quantify, summarize, highlight and decontextualize the soul out of the medical record. Disposing of patients quickly should not be our goal. Other than being demeaning and dehumanizing for all involved, seeing patients quickly is the root of all our health care woes. In an environment increasingly hostile to human interaction, EHRs should ferociously fight to create more time for patients to spend with their doctors. EHRs should automate the business of medicine and eventually the science of medicine, while protecting the art of medicine. And by art, I don’t mean compassion and advocacy. I mean the application of professional judgment, without which the science is incomplete and will always be incomplete, regardless of how many genes we can map or how many bots we can implant in ourselves.

Assuming that the business of health care will be marching along the glorious path currently laid out by our betters, the EHR of the future should endeavor to become a silent background processing machine. Natural language processing should be the first and foremost feature to be implemented to perfection. The EHR should parse and extract useful information from doctor-patient interactions to maximize physician reimbursement by maximizing claim values (yep, I just said that), and by scouring all opportunities to obtain incentives and bonuses from the overlords, and automatically applying for all, without user intervention. Not an easy task, but IBM Watson could drop out of medical school and take this on.

The flip side of maximizing revenue is to cut overhead. No practice needs a scheduler. Let patients schedule themselves online or on the phone. Let them check in and let them room themselves (think about those little restaurant gizmos that beep when your table is ready). Let them take their own vitals and answer all those preliminary questions on their own. For the outliers, the frail and the elderly, one medical assistant can cover these tasks for bigger practices. It doesn’t sound much like an EHR because it isn’t.

What else costs money, but has practically nothing to do with medicine? All the school notes, the back to work notes, the disability forms, trade forms and all other forms, authorizations, pre-authorizations, eligibility checks, statements and everything in between, can be delegated to computerized self-service. Get the medical records online and let patients have at it. Make it user friendly like all other trivial consumer facing apps that have absolutely no bearing on enterprise technologies. Make them colorful and fun. Show pictures, animations and ads. Put them on the iPhone. Monetize the heck out of everything, and remove this purely administrative burden from the practice.

And then comes a moment when restraint needs to be religiously exercised. Stay the heck away from the exam room. Let people say whatever they want to say. Let doctors ask whatever they want to ask. Forget about boxes, no matter how useful they look. Forget about structure too, because Watson will be taking care of that. Don’t make documentation easy, because taking notes is not just about documentation. It is mostly about the background thought process that makes one decide what to note and what to discard. Remember, the way you would use different styles of handwriting and text of different sizes or boldness, and how you added critical notes in the margins, or big pointy arrows? Actively taking notes helps you synthesize information, internalize, memorize and understand the narrative (programmers, think back to your college days).

If EHRs want to be helpful, let them be secretaries. Arrange the notes in a way conducive to better information retrieval. Don’t summarize and don’t impose your (or your machine’s) notions of what is or is not important. Collate and bind everything into a patient book. Remember that this is a reference book and the user can read at a 30th grade level. It is not a cookbook and it is certainly not a picture book. Add a table of contents. Use the computer to make it dynamic. Make it easy to flip pages in an electronic context. Make the fonts nice and large, and do learn from beautifully maintained old paper charts. Go out and look at some before they are extinct. You can’t improve that which you don’t know.

What Will Be

Of course none of the above is going to materialize in a meaningful way, except maybe the infantilized consumer facing EHR. Health care is going retail and health care will care about its customers precisely as much as Walmart and Amazon do. And health care will care for its employees as much as Walmart and Amazon do. When providers are all transitioned to having their employer paid for value, EHRs will become very easy to use. A few big buttons, at the bottom of pages prefilled with stereotypes and sprinkled with colored sparklines, should quickly do the job (i.e. Order, Refer, or Deny). There will be nothing for you to document and nothing for the patient to convey because the system already knows everything there is to know. Eventually, it will dispense with the buttons altogether, and your job will be to quickly explain to your customer why the system did what it did. And you will never have to use a computer ever again. Mission quickly accomplished.



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Clipping Path's curator insight, December 9, 2014 1:31 AM
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