Michelle McNickle, New Media Producer
10 technologies to embrace before EMRs
October 31, 2011
It's no secret EMRs can be complex and confusing, and despite the buzz surrounding their implementation, health IT expert Shahid Shah believes some organizations are better off taking things slow.
"Although most people who are new to healthcare IT always point to EMRs as the most important application, there are many different healthcare IT applications that make up the 'industry' as a whole," said Shah. "When you’re dealing with healthcare IT, EMRs might be a good entry point for some folks, but it’s actually more likely that EMRs aren’t your first place to start your automation journey."
So to help with deciding where your first point of entry into healthcare IT should be, Shah gave us his top 10 technologies to embrace before jumping into an EMR:
1. ePrescribing. According to Shah, ePrescribing is a great way to begin automation since it’s a fast way to see how much slower the digital process is at capturing clinical data. “If ePrescribing alone makes you slower in your job, EMRs will likely affect you even more,” he said. “If you’re productive with ePrescribing, then EMRs, in general, will make you more productive too.”
2. Email. “Internal office messaging and email is a great place to start,” said Shah. “If you haven’t started your office automation journey here, you should.” But, beware of HIPAA, he added. Although it doesn’t prohibit the use of email for sending electronic PHI records, its Security Rule specifies standards for making transmission of PHI via email secure. Regulations include standards for access control, integrity and transmission security.
[See also: EMR links Montana centers.]
3. Microsoft Office 365 and Google apps. When it comes to scheduling and document sharing, “Google and Microsoft have some very nice online tools for managing contacts, or patients, and scheduling appointments,” said Shah. In addition, both tools have “dirt simple” documentation management, he said, which allows everyone in the office to be on the same page. “Before you jump into full-fledged EMRs, see if these basic, free tools can do the job for you."
4. Clinical groupware. This new category of software is an evolving model for the development and deployment of HIT platforms and applications. Shah said the technology helps streamline work and prioritize according to patient. “This is a new category of software that allows you to collaborate with colleagues on your most time-consuming or most needy patients and leave the remainder of them as is,” he said. “By automating what’s taking the most of your time, you don’t worry about the majority of patients who aren’t.”
5. Patient registry and CCR bulletin board. “If you’re just looking for basic patient population management and not detailed office automation, then patient registries and CCR databases are a great start,” said Shah. Although they don’t necessarily help with workflow, they do manage patient summaries. In fact, patient registries have been proven to improve chronic disease care. An article published by the AAFP explains how, although an EMR manages chronic diseases in a proactive and organized fashion, a commercially available spreadsheet program offers the same benefits. “For example, using a spreadsheet program, [such as Microsoft Excel or a database program, like Microsoft Access] you can easily create a list (or registry) of your practice’s patients with a given chronic disease and then use that list to track key measures and remind you and your staff automatically when patients need certain labs and preventive services,” according to the article.
Continued on the next page.
Showing 7 Comments
Sergio Depres say: Advantages and risks of creating foundations for EMR adoption
November 12, 2011 | 11:01 AM GMT
The above presented list of steps contributes to make easier the adoption of EMR, since it is making us aware of those little steps that can be done in advance to have an easier transition. It moves the discussion of EMR adoption to carefully study the relevance of each of the proposed steps in each particular context but it brings another topic. How the adoption of those preliminary steps will not become an obstacle in the later adoption of a full EMR system?
My concern is that adoption of prior individual technologies could create a legacy of processes and applications that later could become an obstacle during the EMR implementation.
I support the idea of adoption preliminary steps prior to full EMR adoption but through a careful selection so that each component later contributes to the EMR implementation.
pjcasey75 say: Some but not all
November 07, 2011 | 18:30 PM GMT
ePrescribing, electronic lab connectivity, email, yes: some of the other stuff you mentioned, not so much.
Some of the things you suggest are so klugy, like Microsoft 360, as to be utterly discouraging to the novice user. Try that breathtakingly slow, featureless solution plus document scanning (with all the naming conventions and filing system requirements) both in one week and you might never touch a computer again. Add the brain strain of learning how to talk differently so a computer can understand you and you might have a headache to boot. At least that's my take - which might not be yours but it illustrates that one size does not fit all.
Plus, once you spend the time learning all 10 of these very different, very separate, non-interoperable solutions and you may have invested a large percentage of the time you might otherwise have spent learning an EHR that is designed to integrate many, if not all the functionality and then some that you've covered here. I'm not saying EHRs are all great, or that implementing any one of them is a piece of cake, but if you're going that route, don't avoid the real thing too long.
Jeff Brand say: great point for first steps`
November 07, 2011 | 17:11 PM GMT
Many in health care and Medical informatics know little about technology. Jumping in on simpler IT solutions like email, groups, windows programs and different types of software packages will get non-software using people up to speed. Most system that have been developed in the last 10 yrs operate pretty much the same. So jump on in, the water is fine.
Jeff Brandt
Holly Spring say: Medical Speech Recognition, a Bit More Info
November 07, 2011 | 09:12 AM GMT
Great check list on getting up and running on an EHR. Speech recognition is referenced, to no surprise, as an EHR-enabling tool. It's proven time and again to help clinicians to effectively use the EHR, allowing them to overcome the constraints of the keyboard and point-and-click template. Hear firsthand how one doctor is using Dragon Medical: http://www.youtube.com/user/SavetheDrNote#p/u/6/5FOVFVh_Nuw
Also, read here on why it's important to use medical speech recognition in a clinical setting vs. consumer speech recognition: http://healthunbound.org/content/speaking-context-medical-language-model...
And, speech recognition comes in more than one flavor, depending on the clinician and workflow needs: http://www.nuance.com/for-healthcare/capture-anywhere/index.htm
dch say: Good points ... but re: speech recognition ...
November 07, 2011 | 08:22 AM GMT
I've been using speech recognition over the past year. My practice environment is not production oriented.
Looking back to my ambulatory care practice years, I can't imagine using speech recognition in a busy practice that requires face-to-face contact with patients. Too disruptive during encounters, and too time consuming to do after encounters. It's good, but not good enough (yet.)
I'm not yet aware of a documentation device as effective as an ink pen and paper in allowing clinicians to preserve a normal human social rhythm to an interview, while capturing data (via regular language, abbreviations, symbols and drawings) in real time quickly enough to allow documentation to be complete by the ends of interviews.
Frederick Graham say: 10 Technologies to use befor EMR
November 07, 2011 | 07:50 AM GMT
This was a great checklist to see what we have done now that the organization has already started implementing EMR.
DonJarrell say: another to consider
It's great to increase awareness for many who are 100% focused on EMR and may not fully appreciate the long cycle of implementation, learning curves, process re-design and mastery that they will have to commit to in order to reap the benefits of EMR systems. But, I do agree with those above that some of the ones listed here are really not going to significantly contribute to the top 2 objectives of an HCO - better patient care and more efficient/productive operation of the hospital.
I believe strongly that many hospitals need to put high on their strategic priority list for CIO, CFO, CCO/CNO and CEO a strategic platform explicitly for performance metrics, analytics and reporting that can integrate all the kinds of measures and metrics needed to effectively manage a hospital. Such a strategic platform must be well-designed and planned for ongoing integration with EMR and other clinical systems, but:
- most EMR systems have several more years of evolution of basic functionality and refinement before they can focus on metrics and reporting
- current design and requirements for EMR systems are dominated by CMS' demands for minutiae more than real patient care and hospital operations
- many metrics that need to be covered originate from, or involve, information that is never near the EMR
- the lowest-common denominator approach - paper, spreadsheets and massive human labor - is horribly expensive and ineffective
- few of the current approaches to metrics in well-established clinical systems really get the body of workers (clinicians) involved in personally seeing and understanding metrics and benchmarks - which has been a critical part of advancing real quality in many other industries.
Sorry for the rant. I hope this registers with a few.
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