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More on EHR's

By Dennis Tribble posted 11-01-2018 10:41

  
Today I read two articles (one from Fortune and one from MedScape) that arose out of a conference last week at Stanford University about the current state and future of electronic health records. These articles focused more on causes of physician satisfaction in interacting with (primarily providing information to) these systems rather than the systems as repositories of information.

I have to admit that I am not abundantly surprised at what was written. I actually practiced institutional pharmacy in a time when what was in the patient's record was whatever the physicians decided to write or dictate, which often did not include things like dates and times or any kind of encoding, But realizing that current systems appear to be insufficiently contextually aware that they ask for things like whether or not an infant chews tobacco (see the Fortune article) starts to get a bit absurd.

Note that this kind of thing is attractive to people who never actually have to use the systems they design.But clinicians tend to demand a certain amount of contextual logic, and will not trust a system that appears to be insensitive to that logic.The system should know that infants don't have teeth... they couldn't chew tobacco, even if their mother gave it to them!. Just like you can't perform a hysterectomy on a male patient. And they distrust any system that fails recognize that certain things are simply not applicable.

While these articles are about physicians, my long history in healthcare automation has taught me that we pharmacists are no different.

So why should we care?

I think we should care because, ultimately, much of the clinical decision support that physicians endure comes from us (at least around medications), and, at some point, we have to confront the notion that the physician (or, for that matter, the nurse) does not take kindly to being forced to do something they think of as someone else's job (like imposing coding on the data they enter). The message from these articles is clear. If EMR's are to become the tools everyone thinks they should be, then their focus is going to have to shift from billing and quality assurance.

What do you think?

Dennis A. Tribble, Pharm.D. FASHP
Ormond Beach, FL
DATdoc@aol.com

The opinions expressed herein are my own and not necessarily those of my employer or of ASHP
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