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?