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EMR vs Tumblr, EMR Issues, and Improving Care

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As we do almost every weekend (every other week on EMR and EHR), we like to take a look at some interesting tweets that we find related to EMR and health IT. We have a bunch of spicy tweets this week that I think each start an important conversation.


My first gut reaction was to laugh. It’s nice that someone is using Tumblr as their therapy for EMR issues. Although, my second reaction is to be a little frustrated that an EMR would be so poorly designed that you could close your EMR in the middle of a report and it wouldn’t be saved. Of course, this isn’t surprising to me since I’ve seen hundreds of EMR, but it is still sad that it’s the state of EMR software today. Imagine if Word was still that way today.


I think this is an important discussion. I think there are workarounds that help this situation. We’ve written about many of them over the years. However, it definitely takes some good design to make the patient the center of the work you do as a doctor and not the EMR.


I love the irony of Farzad’s statement. The real challenge with this idea is that humans can adjust and learn over time much better than computers. At least in the short term. We’ll see how that plays out in the long term as the volume of information that needs to be processed can’t be handled by the human brain.

October 20, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Cutting Down On EMR Clicks

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Few things frustrate clinicians more than having to engage in a long string of clicks to get their EMR work done. But according to a piece in Health Data Management, medical practices can take a series of steps that will gradually reduce the number of clicks practitioners need to execute to do what they want to do.

Contributing writer Katherine Redmond offers a list of changes practices can make which can address some problems with excess clicks without having to get programmers involved:

* Change administrative settings

Many independent ambulatory practices retain significant control of administrative EMR functions, which allows them to tailor some functions to their needs, Redmond notes. For example, she says, most EMRs let users select defaults for specific fields, saving users from  having to pick an option each time.

* Change system configuration

After the practice has used the EMR for a while, and identified areas in which workflow is less than ideal, it’s time to find ways to save time and energy. One way to do this, she suggests, is to develop pick-lists which allow the most commonly selected items to appear at the top. Another possibility is to research the availability of user-defined or custom fields, which can make information accessible that might have otherwise only been available on a distant screen.

* Schedule regular training

To optimize practice workflow, practices should take advantage of  the training resources that come with the EMR, which often include webinars, live chat sessions, videos or customer service calls, she points out. To maximize the benefit of training time, she suggests, there are several options, including pre-scheduling an hour a week or every two weeks to have a call with the vendor, asking the vendor to demonstrate new features, and asking vendor reps to brainstorm methods of streamlining workflow.

In this blog item, I’ve given you a taste of the recommendations Redmond made, but the article has several more to share — I recommend you look at it directly. The bottom line seems to be that practices have more power than they might think to customize their EMR experience and workflow to minimize clicks. Good to know that you don’t have to develop your own EMR to get more of what you want from your system.

August 16, 2013 I Written By

Katherine Rourke 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.

EMR Change Agent, EMR Workflow, and Volume Billing Driven EMR

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I think the article took a little different take on the tweet than I did when I first read it, but I love the idea of using the EMR as a powerful change agent in your organization. Many executives say they wish they could change some things about their organizations. EMR can be one method to help implement some of those changes. Far too few are using it to really effect change for good in their organizations.


This feels a bit like semantics for me and you know I avoid semantics. What I do know is that EMR can make an ugly workflow really ugly or a beautiful workflow really beautiful.


This road already seems paved. The question I have is whether we’re willing to rip up the road and replace it. There’s some signs that it’s going to happen, but I’m still not confident in those signs.

June 2, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Problems EMRs Don’t (Necessarily) Cause

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In publications like this one, we spend a lot of time and energy clubbing EMRs and EMR vendors for the problems they cause.  That’s all well and good, but it’s also worth remembering that some of the big problems surrounding medical operations may not be due to EMR use:

* HIPAA carelessness:  When someone shouts private medical information across a room, or loses a flash drive or tablet with records on it, or leaves patient records in a public place, you’ve probably got a nasty HIPAA violation. But the EMR almost certainly had nothing to do with it.

* Clumsy office workflow:  Sure, introducing an EMR into a clinical setting can screw up existing workflow. But was it working well in the first place?  For those whose business falls apart post-EMR, I’d argue “no.”  Businesses that don’t do well after an install had jury-rigged processes in place already, I’d argue.

* Patient care slowing down:  As with staff workflow, clinical workflow can be discombobulated — badly — by an EMR installation. Learning to fit practice patterns to the system is a big job for most clinicians, and they may slow down significantly for a while. But if the patient care flow stays “broken” it’s likely that there were aspects of the pre-EMR system that didn’t work.

I realize that I might get flamed for saying this, but I’m pretty confident that a goodly number of problems that are laid at the feet of dysfunctional EMRs don’t belong there.  And that’s not a good thing.

After all, there are enough poorly designed, trouble-ridden EMRs out there to keep us busy critiquing them for a century or two.  Why distract ourselves by adding more to the pile when the real issues may be elsewhere?

January 29, 2013 I Written By

Katherine Rourke 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.

EMRs Can Spark Creativity

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Today I’ve been letting a few curious little theories germinate in my head. So I thought I might try out an idea on you good folks.  For those who have read my previous rants about breaking a doctor’s workflow, this may seem rather contrary, but hey, we can always duke it out later.

Yesterday, I went to see a specialist who’s a member of a decent sized practice (about a dozen docs, give or take).  The office is completely paper-based, efficiently and elegantly if my patient’s eye view is any indication.  The practice is something of a zoo — super-high volume — but I seldom if ever feel rushed or impatient.  In other words, we’re talking what looks like a pretty well-run shop from the pre-EMR era.

When I saw my doctor, we puzzled together a bit over a medical issue I’m facing, one which could be drug-induced or could be organic.  We spent some time talking about standard solutions and how to manage them and then, boom, my specialist had an inspiration.  We agreed that I should taper off one medication and begin the other shortly.

Luckily for me, my doctor was engaged and seemed interested in digging into the problem.  But in other cases, realistically, I might have gotten a physician that stuck blindly to the obvious and didn’t dig up what might be a slightly unconventional solution.

Here’s where I contradict myself to some degree.  In past essays, I’ve written on how inelegant and undesirable it can be to break physicians’ workflow for the sake of squeezing an EMR into place. I’ve argued that EMRs should be designed for physicians and not for administrators. And so on.

This encounter, however, convinced me that when EMRs break passive, standard workflows, it could be a spur to creativity in some cases.  In the right situation, if the doctor I saw was distracted or bored, the EMR could throw second line solutions at him or her just when they were ready to e-prescribe and sign off on the visit. (Yeah, a “do you want to leave this chart now?” prompt with a med recommendation might be annoying, but it could be productive!)

Of course, no system can force a physician to engage if they simply don’t want to do so, or don’t have time to think. But if the system is designed right, maybe the changes EMRs engender can lead to fresh ideas, better grasp of details or just a reminder on a bad day.  At least I hope so. What do you think?

June 15, 2012 I Written By

Katherine Rourke 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.

Should EMRs Force Workflow Changes?

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Today, I was lurking in the EMR and HIPAA Facebook chat where some readers and publisher John Lynn were talking of things EMR-related.  During that chat, one exchange really brought home to me how far we have to go in even agreeing on how the ideal EMR should work.

During the discussion, one chatroom member said that the biggest problem with EMRs is still that they force doctors to break their workflow.  Another stalwart chatroom member, the insightful @NateOsit, retorted that EMRs should break workflow patterns, as this would promote healthy change.

Well, there you have a conundrum,  if you look closely enough. While people seldom speak of the issue this directly, we’re still arguing over whether EMRs should fit doctors like a glove or change their habits for the (allegedly) better.

This isn’t just an academic question, or I wouldn’t bore you with it. I think the EMR industry will be far more wobbly if the core assumption about its place in life hasn’t been addressed.

At present, I doubt EMR vendors are framing their UI design discussions in these terms. (From the looks of some EMRs, I wonder if they think about doctors at all!) But ultimately, they’re going to have to decide whether they’re going to lead (create workflow patterns that follow, say, a care pathway) or do their best to provide a flexible, doctor-friendly interface.

I’d argue that EMRs should give doctors as many options as possible when it comes to using their system.  Perhaps the system should shape their workflow, but only if the users vote, themselves, that such restrictions are necessary.

But the truth is that when a hospital spends a gazillion bucks on a system, they’re not doing it to win hearts and minds, no matter how much they may protest otherwise.  And when a practice buys a system, they’re usually doing it to meet the demands of the industry, not give their colleagues their heart’s desire.

So let’s admit it.  Though I don’t argue that they’ll ultimately be put to great uses in some cases, ultimately, EMRs are about dollars and bureaucratic face-saving.  So, today’s workflow will just have to take a back seat.

May 30, 2012 I Written By

Katherine Rourke 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.

Meaningful Use Doesn’t Address ‘Hybrid’ Transition Period

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Some 10 years ago, when I first started covering health IT, a lot of the talk was about the “modular” approach to EMR adoption, i.e., put in a piece at a time during a transition period. Much of that had to do with the state of technology at the tail end of the dot-com bubble, when companies developed applications to address one small problem, often in the hopes of getting a larger firm to shell out big bucks for their idea. (Wouldn’t you know, that’s how many vendors, most notably GE Healthcare, put together end-to-end enterprise systems.)

Implicit in any step-by-step transition to EMRs was the idea that there would be an interim period where providers would have to run dual electronic and paper systems. It’s a notion that’s always been with us, but how many people still think of it?

I got a reminder this afternoon when I spoke to Ken Rubin, Iron Mountain‘s senior VP and GM for healthcare, who was talking about results of a new survey on progress toward meaningful use. (I was ostensibly doing that interview for InformationWeek Healthcare, so look there tomorrow for coverage. Here, I just want to talk about one aspect of the conversation.) Rubin noted that there seems to be a sort of “no-man’s land” between the paper and digital. “I don’t see a real, well-defined way of dealing with the hybrid world,” when hospitals and medical systems are switching to EMRs while still retaining old paper records.

Obviously, Iron Mountain would like to sell some scanning, data management and shredding services to healthcare organizations, but Rubin has a point. The rules for meaningful use Stage 1 don’t say a thing about what you’re supposed to do with existing paper files, and it doesn’t appear that Stage 2 will address that issue either.

Do you scan all the old files immediately, or wait until each patient’s next visit, then chart electronically going forward? What do you do with the files of inactive patients? Do you archive records in house or offsite? Do you still need rows of files taking up valuable square footage that could be put to better use? What do you do with clerical staff?  Do file clerks become managers of electronic health information, or do you need to replace those people with others trained in HIM?

Rubin noted that this limbo often works against organizations trying to overcome physician resistance to change. “The faster you can get to the other side, the faster you’ll get physician adoption,” he said.

That all makes good sense to me. CIOs and practice managers, what do you think? Have you addressed hybrid workflow during this transition period, or is the siren call of federal dollars for meaningful use too strong?

 

July 7, 2011 I Written By

Various Clinical Workflows – Oncology in Particular

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I’m always interested in interacting with the readers of this blog. Plus, I like to help people out that email me asking questions. Plus, I’m swamped preparing for HIMSS and putting the finishing touches on my EMR selection e-Book. So, here’s one that I think was more than worthy of a discussion:

I am concerned with some of the specialty medicine aspects of EMR, specifically those of Oncology. Do you think there would be room for discussion of the different types of workflows different types of practices face? I would love some outside views of how different Oncology practices plan to convert their workflows to an electronic form.

I am also interested in learning more about different in-house architectures.

-Nick

I’d love to hear people’s comments about this as well. You know I think workflow is one of the keys to a successful EMR implementation. So, what type of special workflows have you created to make EMR work for a specific specialty? Has anyone had experience implementing an EMR in oncology? Let’s hear your thoughts.

February 26, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Balancing Workflow Customization with an EHR

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I’m a HUGE proponent of mapping your current workflows and evaluating how that applies to your EMR implementation. It’s absolutely essential to be able to do it right. It’s not an easy or necessarily fun task, but it pays big dividends when you go live with an EMR.

However, far too many people get caught up with “my workflows” versus the “EMR workflows.” Some people like to argue that an EMR vendor should be able to customize their software to be able to support my current paper work flows. Other people argue that you should toss aside your current workflows and adopt the “best practices” standards of your EMR vendor.

Of course, the real answer is as it should be: somewhere in the middle. The EMR should be built so that you can customize many of the features to match the way you see patients and the way you practice medicine. In fact, this should be part of the evaluation process when selecting an EMR vendor. However, let’s not also be naive enough to think that some things in the electronic world won’t be easier to do than they would have been in the paper world.

You better hope that your EMR implementation does change some of your current processes for the better. That’s part of the reason why your implementing an EMR. You want to improve something about your clinic. If nothing changed, then where would the improvement come from?

Like everything in life, workflow customization just requires balancing your current workflow with the EMR vendor’s suggested workflow and the features of the software.

January 4, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

EMR Implementations Change Workflow

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I saw an EMR demo today and they made a really interesting point about workflow. In fact, I was impressed that the EMR vendor admitted up front that you would need to change your clinic to work with their EMR software. I’ve said this a number of times on this site, but it was kind of refreshing to hear an EMR vendor admit it. I’ll have more on the rest of the demo/presentations in future posts.

What was most interesting was that after admitting that you would need to change the way you work to use an EMR, he made a really interesting and powerful point. The basic concept was that if you don’t have an EMR, your current workflow is bound by the paper world in which you now live. Hopefully, adding an EMR to the mix provides some new ways to serve patients that were impossible to accomplish in the paper world.

I think you could also add that implementing an EMR removes a bunch of paper queues. For example, we use to have a half sheet of paper that was filled out by the patient follow the patient throughout the entire visit. What were we going to do without that half sheet of paper? This is one of those workflow changes that isn’t a deal breaker, but just had to be considered and planned for.

Also, don’t confuse changes to your workflow with changes to how you treat a patient. Your workflow will absolutely change. We’ll save how an EMR affects how you treat a patient for another post.

September 4, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.