Five features missing from most EHRs

While EHRs are increasingly essential for healthcare providers, their efficacy can be constricted by the nature of their design, their use and the interpretation of data.

Jerry Buchanan, Program Manager and Scrum Master at eMids Technologies, Inc., an IT and BPO consulting company, weighs in on some features that are missing from EHRs:

1. Information, not data

While EHRs hold data, that's not the same as holding information, Buchanan notes. Data needs to be converted into relevant information to be of practical use. However, there's also the possibility that EHRs can get overloaded with information. The goal, Buchanan says, is technology that organizes data in a way that assists healthcare providers most efficiently and effectively in making clinical decisions. This includes EHRs capable of providing alerts and alarms about patient conditions, given to caregivers in real time.

2. Comprehensive health history

Buchanan says that clinical data is usually entered into an EHR after a health episode. He notes that a history of recorded episodes is not the same as an overview of someone's health history. Some health systems are beginning to change this feature, propelled by the needs of chronic disease management, Buchanan says. Ultimately, it may be the standard for all patients.

3. Information tailored for various users

Who is the audience for the EHR's information? Buchanan says information is most useful when it matches the needs of various recipients. For example, a cardiologist, a primary care physician and a nurse might have different needs when it comes to the type of information and the level of detail they seek about a patient. Ideally, an EHR would be configured to the needs of the individual end-user.

4. Tracking the transition of care

Appropriate patient care is not static -- it must flow from one caregiver to another, from one facility to another. An EHR works better for a patient if it includes features that track tasks -- such as giving medications, monitoring conditions and administering medical tests -- to completion, and then reassigns them, if necessary.

5. Patient-side management of information

Buchanan says the ultimate EHR would give the patient -- the consumer -- the ability to manage just what health-related information (HRI) is available to which practitioners.

 

What features do you feel are missing from your EHR? Leave your comments below.

Showing 7 Comments

Shea PF say: EHRS are far mor effective than paper

I think what is important to note is that in the long-run,the EMR benefits outweigh any cons and issues with current system functionality. With Meaningful Use incentives starting to shell out, EMR vendors are primarily focusing on Stage one requirements more than any other request, luckily a lot of what doctors are requesting is what the ONC wants too. The best EMR software is the kind that can quickly update itself without having to re-install or have someone come in and that's why web-based applications are superior to client-sever systems.

pjcasey75 say: It won't work because medicine isn't a game.

I agree with the previous comment. Current interface technology, suitable for games, is not yet "there" when it comes to inputting medical data. Voice recognition software still boasts a 97% accuracy rate. But when it comes to medical information, which is highly technical, the rates go down. And 97% means 3 words out of 100 are wrong. We can't simultaneously continue to harp about badly handwritten notes and then say it's okay to make mistakes on critical medical records at that rate.

Even from a practical, competency standpoint, as an illustration, how would you react to this comment if I had 5 obvious spelling or contextual mistakes out of these 162 words?

Until then, selecting from standardized options is the only way to capture structured, accurate, reliable data.

However, I do agree that we should keep our eye on areas like game technology because the technological fringes are always the place to look for innovation and new ideas - in the future.

Patrick J. Casey, AvivaEMR.com

Heather Toll say: The advantage of document-based EMRs

Keep in mind that busy doctors and nurses are used to paper charts and already feel a lot of time pressure from the realities of dealing with a lively practice. Add to that the fact that they are getting a lot of pressure to move to EMR/EHR, possibly before they see all the benefits. Throw adapting to a whole new interface on top of these already-mounting pressures, and you are just adding to the resistance factor.

As IT people, we are used to and love the “gee-whiz” features of GUIs and game-type interfaces, and, yes, these might be great once medical staff are used to working with electronic data. In the meantime, however, patients want doctors to start using EMRs, and medical staff want something that will be an easy transition. Given this current situation, document-based EMRs make sense.

Heather Toll
TAZ Networks, Inc.
www.thehealthcareitcompany.com

dpeelmd say: 5 features missing from most EHRs

Bravo to Jerry Buchanan for pointing out the future of EHRs----they will empower patients to control who sees what (segmentation) and and who sees their information at all.

The Coalition for Patient Privacy has room for HIT vendors who subscribe to our consumer-developed privacy principles.

See:http://patientprivacyrights.org/coalition/

Deborah C. Peel, MD
Founder and Chair, Patient Privacy Rights

pgflrob say: The problem is Microsoft

EHR developers are fixated on Microsoft. They start out with a bias to coding to IE or .Net UI standards. This is the easy path but you end up with applications that are mouse and keyboard centric. This is an insane way for doctors to work with HC information.

In 3-5 years all EHR implementations going in today will be obsolete. They will be replaced at huge costs with EHRs with user interfaces that look more like Star Trek or even the interactive new-screen on CNN.

Developers need to abandon Windows and IE and look towards game, simulation, and iPad UIs for clues.

Green_Leaf say: Five features missing from most EHRs

I completely agree with Jerry. Many systems have user interfaces that are still rooted in mainframe text-based screen technologies. The human interfaces need to catch up to the advances that the gaming world has developed and refined. Even the military has acknowledged that these interface devices are intuitive and already have a large user base.

Not only does the data need to be tailored to the user, it must be coherent displayed to provide information so that the user does not have to sift through multiple screens to find the data. These systems need to adopt current technologies such as hover over expansion of data and better use of graphics.

EHR generation 2 or 3 should probably bring usability that is intuitive.

Raymond Simkus say: Five features missing from most EHRs - GUI

I agree with the previous comments. I saw what was called an "intelligent graphical interface" or IGI over 10 years ago. It was very advanced yet it has not penetrated the legacy row and column interface. It seems that many current EMRs are not much more than electronic versions of paper charts that shuffle various parts of the record on and off the screen. Little attention is paid to the creation of linkages between different parts of the record. Little use is made of smart icons that could provide the user with some indication of the information that is connected to that icon. Sophisticated graphs that are available in other industries are virtually unknown in the EMR domain the excuse being that that no one is asking for them. Physicians themselves will often say that they would rather see the numbers rather than graphs. I suspect that this is because they have only seen poorly designed graphs and they have been taught in medical school to look at the numbers.