Rx for MD EMR: 1 Tab QD

By John W. Loonsk, MD
03:58 PM

Billions in stimulus dollars have many physicians now eyeing electronic medical record software for their practices. Hospitals are installing EMRs (for providers?) too. Unfortunately for many who practice care, EMRs are still a pretty bitter pill to swallow.

The truth is written all over HITECH. The need to still "realign incentives" actually means that others, not providers or patients, still benefit most from EMRs. Extension Centers needing to provide "workflow support" is a harbinger of just how much today's EMRs require reorganizing a provider's daily activities. "Needs for usability certification" means that – you guessed it – even with workflow reorganization, this software is really hard to use. In fact, the entire premise of a provider incentive payment program is recognition that there is a need for significant help to get the EMR castor oil to go down.

Treatment at hand

One possible source of hope is that the new tablet computers can make the EMR “pill” easier to swallow. Tablets are by no means a full prescription for provider EMR woes, but under the right circumstances they can sure help.

First, and most obviously, there is the form factor of the new devices. They are slim, light, slate-like computers with long battery life. They are not locked to a desk but are carried around like a personal clipboard and don't require a mouse, stylus or other distracting input device. The form factor avoids having the provider turn his back to the patient and it is not a major physical impediment between providers and patients when they are facing each other. Overall, as a computing device for clinical care, this is an order of magnitude improvement.

The tablet's support for easily manipulating information with gestures is a close second feature. Not only do tablet touch screens make pointing to things more intuitive, they present a treasure trove of developing information navigation gestures that leverage squeezing, expanding, swiping, dragging, dropping, sliding, flicking, turning and more. Well implemented on a responsive tablet, these gestures can really make information fly.

More therapy needed

For full effect, the gestures need to operate along with new ways to visualize health records and data. Imagine a "visual chart," if you will, where the different visualization metaphors align with appropriate manipulation gestures to improve information consumption and awareness and not slow or impede it. The visual metaphors I am talking about are not like those that make a book selection screen look like a bookcase, but those that implement new ways to focus on finding and attending to important data at hand.
Xerox PARC and others have developed paradigms for scrolling information walls and other techniques that have already found their way into general tablet use. The combination of visualization metaphors and manipulation gestures on tablets can have them appealing to everyone from toddlers to senior attending physicians.

EMR software, though, is not yet close to implementing the full visual or gestural paradigm opportunities. As an example, the use of medical "widgets" needs to be exploited. Instead of always being fully and exclusively in a single EMR application, widgets that expose constantly updated data on the tablet desktop could manifest patient lists, pending tests and other useful medical information constantly on the busy, multi-tasking, provider's tablet "desktop.”

As another example, physicians have resisted decision support “alerting” that blocks their workflow and forces stepping though a series of sequential actions. With multi-panel desktops on tablets, there are other metaphors for "notifications" and prominent representation of information in widgets that are less intrusive, but may have comparable effects.

Personalized medicine

Part of the current value of tablets depends on their being a personal device, customized by the user, with resources and tools that meet their unique needs. Many a health organization has so locked down their clinical workstations with limited access and security constraints that they barely resemble information tools let alone personal information devices.

It is important that providers fight to "own" the tablet desktop or will it be "owned" by the care organization and lose great value.

Reducing the co-pay

Finally, it would be wrong to not also point to the "app store" access and cost model that is prevalent on tablets, too.

Applications are easily downloaded and installed by the masses, allowing for greatly reduced pricing. The model requires a heavy degree of standardization. On the tablets it is implemented though the commonalities of the operating system.

For providers to have a similar level of standardization on their medical devices they will have to begin to think of the computer as more of a "cure" than the disease itself and express their demands for their treatment.


John W. Loonsk, MD, FACMI, is chief medical officer of CGI Federal

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