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A List Of Must-Have EMR Features

Posted on July 28, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

When a doctor tells you what features they believe need to be in an EMR, it’s worth a listen. And when that doctor has personally managed the ongoing development of their own EMR, I find their ideas to be even more interesting.

Such informed recommendations are just what Hayward Zwerling, MD, has to offer. Zwerling is a practicing physician, and also the creator of the ComChart ambulatory EMR, which he launched in 1990 and kept on the market until 2015. Zwerling recently published a list of features which, he argues, should be in virtually every EMR. Below, here’s a sampling of his suggestions:

Lab features:

  • Provide a button displaying all abnormal lab results, and make the resulting list sortable by test name, test date or any other available parameter.
  • Allow the physician to display any subset of the patient’s lab results, and offer an option to omit individual results and resort the displayed data. Also, allow doctors to export the data in cvs or Excel format.
  • Permit doctors to create lab test charts on the fly, including any combination of tests from the patient’s existing lab work. In addition, make it possible to incorporate this chart into a Progress Note approved up to chart for the patient.
  • Make it easy for the doctor to create an association between incoming test results and specific medicines. (For example, if a cholesterol test result appears, include the name of any statin the patient currently takes.) And make it possible to create lab charts which include concurrent medication information, with just one click.
  • Clearly display who ordered a test and to whom a copy of the test was distributed.

Progress Notes:

  • Allow physicians to create test result charts from within the Progress Notes section.
  • Permit physicians to add selected free text from the Progress Notes to the problem list, medicine list, allergy list, family history or old problem list by highlighting the data and clicking a single button.
  • Create a free text field on the Progress Note layout allowing doctors to enter information that is not an official part of the patient’s chart. For example, the clinician might write a note such as “Daughter wants issue of her mother’s depression to be discussed at the mother’s next visit, and daughter does not want to be identified.”
  • Allow doctors to search free text Progress Notes for a word or phrase. Also, make it possible to search some or all of the entire EMR’s free text Progress Notes in this matter.

Zwerling goes on at much greater length in his post on The Health Care Blog, so much so that his suggestions spill over into a separate blog entry. But this subset of suggestions make the point on their own. He clearly believes — quite reasonably — that doctors should have access to simple, easy-to-understand tools when they use EMRs, and that there should be no need to refer to a manual or attend training classes.

He sums it up thusly: “The feature should be presented to the user in a manner which make it intuitively obvious how to utilize the feature.” Really, don’t we all agree with him? And if so, why are so few EMRs organized this way?

EHR Vendor Says Good Bye to Meaningful Use

Posted on December 30, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

ComChart Medical Software, LLC president, Hayward K. Zwerling, MD, earlier this month posted a letter on The Health Care Blog saying that the ComChart EMR would no longer be meaningful use certified. Here’s a portion of the letter that describes the reasoning:

ComChart EMR will continued to be certified as a Complete EMR for Stage I Meaningful Use. Unfortunately, we will not be able to meet the Stage 2 (or greater) Meaningful Use certification requirements as these requirements are technically extremely difficult to implement.

In addition to the Meaningful Use mandates, there continues to be a never ending stream of new mandates such as ICD-10, PQRI, Meaningful Use 2, Meaningful Use 3, SNOMED, ePrescribing, LOINC, Direct Project, health information exchanges etc. As a result of the mountain of mandates, ComChart EMR and the other small EMR companies will have to choose to implement the mandates or use their resources to add “innovative” features to their EMR. Unfortunately, the small EMR companies do not have the resources to do both.

(I suspect this is also true, to some extent, for all EMR companies.)

While the individual people involved in promulgating these EMR mandates (mostly) have the best of intentions, they clearly do not understand what transpires in the exam room, as many of the mandated features confer little or no benefit to either the patient or the healthcare provider.

In addition to a lack of understanding of what is important during the process of providing healthcare, it has also become apparent to me that the Federal and State health information technology agenda is now largely driven by the strongest HIT companies and health institutions; the individual physician is only an afterthought in the entire process.

This choice basically means that anyone interested in meaningful use and EHR incentive money won’t be doing so with ComChart EMR. The regulations say that even someone attesting to meaningful use stage 1 in 2014 has to use a 2014 certified EHR. ComChart won’t be able to meet that requirement.

I knew that this was going to happen with a number of EMR vendors, but ComChart really missed a huge opportunity with this announcement. The most damning part of the letter is when Dr. Zwerling says “we will not be able to meet the Stage 2 (or greater) Meaningful Use certification requirements as these requirements are technically extremely difficult to implement.” I was aghast by this statement. So much so that I had a brief email exchange with Dr. Zwerling to see if he really meant what he said. Was it that they weren’t able to meet the requirements or that they chose not to meet them?

He responded, “Anything can be done, it is just a question of how much resources are going to be thrown at the problem and what is not going to get done return.”

It seems that Dr. Zwerling didn’t consult a PR or marketing person on how to make the most of this decision. Any of them would have told him that this decision could be a huge opportunity to differentiate the ComChart EHR from all the hundreds of certified carrot chasing EHR companies out there.

If Dr. Zwerling had asked me, I’d have told him that he should have said, “ComChart EHR has talked with our hundreds of physician end users about meaningful use and EHR certification and we’ve found that they don’t value any of the meaningful use criteria. Because of doctors desire to not be bogged down by meaningful use requirements, we’ve chosen to listen to our doctors and focus on what makes doctors lives easier. We’ll continue innovating our product to the needs of doctors, but we’ll be letting doctors drive that innovation versus some committee in Washington.”

I could keep going, but you get the idea. ComChart could have told every doctor out there that they were the ULTIMATE PHYSICIAN EHR that cares so much about the physicians who use their EHR that they’re shunning meaningful use because it’s detrimental to the way physicians should be practicing medicine. Making this case would not be hard and the message would resonate with the majority of physicians.

I’m not sure if this strategy would work or not. Government money that’s perceived as “free” is a hard opponent. However, government bureaucracy and headaches are an easy target that everyone understands and hates. In ComChart’s case, saying that they essentially aren’t capable of the complex meaningful use requirements is sending the wrong message. All doctors hear when they read this is that your EMR development team isn’t sophisticated or strong enough to keep up. What a missed opportunity and likely the nail in ComChart’s coffin!

Hopefully this is a warning message to any other EHR vendors who choose to go the route of shunning meaningful use and EHR certification. I’m not sure that shunning MU is a winning strategy for an EHR vendor, but being the physician advocate at least gives them a fighting chance.