I had a chance to read a compelling discussion regarding the need for a significant change in the way that electronic medical records (EMR) products interact with physicians. While a lot of this discussion centered around removing regulatory and administrative tasks from the clinician interaction with the patient, it also talked about changes in design, configuration, and implementation of these EMR products.
This reminded me of a concern I have had for some time that our healthcare products in general seem to heavily rely on user interface technologies that were designed for use in business applications which are both less information intense and less time-sensitive than healthcare. The continued use of these elements result in data presentations that overwhelm the user with tables of detail while providing very little sense of the overall direction of the patient’s care, and often require the user to scroll or page through these “haystacks” of detail to find the ”needle” that is actionable and intelligent. On-screen forms add to this by artificially breaking information out into the data constructs required by the underlying database structures, rather than accepting and processing information supplied in clinical terms and parsing that terminology into the data structures as appropriate.
By stark contrast, the software I use to prepare my taxes does things like:
· Remembering and verifying things it already knows about me.
· Acquiring information required to do its job from my accounts and records on my behalf.
· Only demanding that I fill in information that it could not acquire on my behalf or for which it was uncertain regarding the correct treatment of that data.
· Maintaining a clear picture of where I am in the process of submitting my taxes.
· Eventually selecting and completing the appropriate tax forms from those other sources of data.
I am not suggesting that all clinical care is as relatively straightforward as filing income tax, but that experience suggests to me that there are ways that software can be built to permit a caregiver to focus on their patient, and not on their insurance company. There are probably ways to help structure that note so that the caregiver only needs to enter data where it is not clearly derived from the information already available. We know from many current applications that it is possible for a text editor to identify the probable course a sentence is taking and facilitate completing it. My word-processing software is doing that as I write this.
I will confess I don’t know what a “good” user interface might be for healthcare providers. I know only that such interfaces built on forms and tables seem to have created as many problems as they have solved. They are easy to build; the tools are readily available. But should that ease of building constrain us from solving the problem of an easy-to-use EMR?
What do you think? If you could make an EMR system any way you wanted, what would it look like?
The thoughts of this blog are my own, and not necessarily those of my employer or of ASHP.
Dennis A. Tribble, PharmD, FASHP
Ormond Beach, FL
datdoc@aol.com