While browsing a thread on my favorite EMR forum, I found this intrigueing post by Matt Chase (someone who I deeply respect and the MD behind Medtuity EMR). Matt created an interesting list of requirements for building an efficient EMR. He created this list to dispel the notion that the government could create an EMR software and offer it to doctors for free. I’m sure this isn’t a complete list and I disagree with some of the finer points, but if every EMR was able to do the things on this list, those using EMR would be much happier. Take a look at the list of EMR requirements:
The record must be totally collaborative to allow anyone in the office to open and chart without regard to others having the chart open.
There must be security. An audit trail.
It must be very customizable for the practice. No EMR company in the world has all the medical expertise to have the latest and greatest templates for every specialty. Customizing must be simple and intuitive but a template which is customized now, cannot in any way harm the documentation done previously with that template. Just think of the new procedures, treatments, lab tests, medications and more than arrive daily.
It must be capable of collecting that information, slicing and dicing it with great discrimination, and conveying that information to other health systems software.
It must be capable of running client-server or self-contained on a laptop.
It must be affordable. This $25,000 or more per user is ridiculous. A government funded EMR should be affordable out of cash flow– that is, no upfront purchase of the software, but rather, turnstile pricing.
It must be intuitive.
It must be “graded” in its operational capacity. A new user can use obvious features but as they mature in their EMR awareness, more features can be accessed. There is nothing like “need” to inspire to user to learn another step. That is, filling out a lab form is too slow and so if the user wishes to switch to a bidirectional lab interface, it should be available. If they don’t care, then at least give them the option of the software filling out the lab request form.
It must be easy to assist users who experience difficulty. This is one of the most important items by far. The ease of assisting a user will make or break many EMR installations. My preference is to have the ability of the user, with a single click, to show their desktop to technical support, whether that technical support is in their large facility or in another prearranged site.
It must be easy to update, including all the SQL schema changes, executable versioning, new clinical content, and so much more without the use of IT staff. If for every update, someone in the practice must go from computer to computer to update it, updates will never get dispersed. Already the bar is too high.
It must be relatively simple to install, not requiring a dedicated IT professional.
It must be capable of allowing the practice to be paperless. To design it short of that would ignore a significant percentage of the market. That means document management in the many forms of documents– tif, jpg, doc, txt, pdf, Outllook emails, html, and even CCR. Additionally, it should be capable of outputing all those scripts, excuses, referrals, letters, and more. It should handle telephone triage (as it’s called in pediatrics) without generating a sticky note for the chart. It must have a forms feature.
It should have alerts, messaging, and reminders for those who wish to use them.
It must be fast. You want no one complaining of speed.
Anything else you think should be added to the list? Anything you see that shouldn’t be on the list?