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EMRs Can Spark Creativity

Posted on June 15, 2012 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.

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?

Meaningful Use Doesn’t Address ‘Hybrid’ Transition Period

Posted on July 7, 2011 I Written By

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?


Imagine an EMR without Billing

Posted on August 22, 2010 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

For today’s weekend post, here’s a thought provoking comment:

Imagine what EMR software would look like if it didn’t have to worry about billing, insurance and reimbursement. Would we then see much higher quality EMR software in regards to patient care and physician workflow?

I look forward to reading your thoughts.