The EMR Language

Written by:

If you haven’t read this insightfully candid post by Rob Lamberts, MD, you should go check it out now. Here’s the opening which should get you intrigued:

OK, I’ll admit it: I had no idea. I thought that the whining and griping by other doctors about EMR was just petulance by a group of people who like to be in charge and who resist change. I thought that they were struggling because of their lack of insight into the real benefits of digital records, instead focusing on their insignificant immediate needs. I thought they were a bunch of dopes.

Yep. I am a jerk.

My transition to a new practice gave me the opportunity to dump my old EMR (with all the deficiencies I’ve come to hate) and get a new, more current system.* I figured that someone like me would be able to learn and master a new EMR with ease. After all, I do understand about data schema, structured and unstructured data, I know about MEDCIN, SNOMED, and HL-7 interfaces. Gosh darn it, I am a card-carrying member of the EMR elite! A new product should be a piece of cake! I’ll put my credentials at the bottom of this post, in case you are interested.**

So, imagine my shock when I was confused and befuddled as I attempted to learn this new product. How could someone who could claim a bunch of product enhancements as my personal suggestions have any problem with a different system? The insight into the answer to this sheds light onto one of the basic problems with EMR systems.

Since he said it, I had to take a look at his “credentials” to provide some perspective on the post as well:

  • I did my residency at Indiana University, the land where Clem McDonald, one of the pioneers of electronic records made our records electronic when personal computers were still new (I attended from 1990 to 1994). It was there I became a believer in computerized records.
  • In practice, I installed MedicaLogic’s EMR in 1996, as one of the first users of their Windows based product, Logician.
  • Within 2 years I was on the user group board, and was elected president in 1998. I was a regular speaker at the conferences and known for my profuse production of clinical content (called “Encounter Forms”)
  • In 2003, I applied for and won the HIMSS Davies Award for ambulatory care for our practice, recognizing our achievements with EMR in an ambulatory setting.
  • After that, I served on several committees for HIMSS, gave talks for multiple other groups (NHQA, National Governors Association), giving the keynote talks for the HIMSS series given around the country to convince docs to adopt EMR.
  • In 2011, I participated in a CDC Public Health Grand Rounds as a speaker from the physician perspective on the subject of Electronic Medical Records and “Meaningful Use.”

Finally, he ends with the money quote, “So to those I have scorned in the past, I bow my head in shame. I got good at using a complex tool that allowed me to manage the insanity of our system. It turns out that my skill was a very narrow one.

There are so many fascinating things about this post. Many of which we’ve discussed many times before here at EMR and HIPAA. The first one that I want to highlight is the idea that EMRs were developed around our insane payment system as opposed to around amazing patient care. Long time readers might remember my starry eyed dreaming about what an EMR would look like if it didn’t have to worry about billing. Sadly this isn’t the state of EMR software and likely won’t be in the near future. However, it is the biggest challenge that an EMR vendor faces.

Dr. Lamberts is right that there are good and bad parts of every EMR system. No EMR system is perfect. Instead, each one does certain things really well and certain things subpar. This is a feature of pretty much every software. When an EMR system doesn’t do something well it could be because they just haven’t had time to optimize it. Although, more often, their are subtle development issues which make changing an EMR workflow very difficult. Not to mention the impact of a subtle workflow change to your existing EHR users.

Thinking back to Dr. Lamberts post, he talks about how he’d become an expert on the intricacies of his EMR software. If his EMR vendor were to change that workflow to a more optimized one, he would have revolted. Maybe the new workflow is better, but the fact that he knew the old workflow has value as well and changing it has its own costs. Thus the challenge to updating any EMR software.

No EMR is perfect. Choose the EMR whose challenges you don’t mind dealing with on a daily basis.

Another message I get from Dr. Lamberts post is not to give too much value to awards, groups, and industry committees. Not that I really did before anyway. I’ve always been a take it with a grain of salt kind of guy.