EMR Disappointment And Acceptance

This past summer I was on a train in the Paris area and happened to share a train car with someone who was also from the East Coast of the US. We chatted and found out that he was a doctor, which always makes me slightly tense. Sure enough, once I mention that I am a medical information systems specialist we somehow end up on the topic of how bad so many of them are.

Why is that? I assume so many health care professionals have so little regard for their Electronic Medical Records system and other e-tools of the trade because these tools are not very good.

At least these medical informations are not very good at supporting many of their users. These medical information systems probably excel at supporting corporate goals or IT departmental goals.

The specific complaints by my companion on the train were painfully typical:

• the screen layout is cramped and crowded;
• the history available on-line is too short;
• the specialized information (labs, x-rays, etc) are not well presented;
• the data is biased toward general medicine and internal medicine.

But what struck me about our conversation with his resignation. While we rehashed the usual complaints and frustrations with large Commercial Off-the-Shelf (COTS) systems, he was more resigned than anything else. He just doesn't expect anything more from the software supporting his efforts to deliver clinical care.

We expect great things from our smart phones. We have high standards for our desktops and laptops and tablets. But somehow we have come to accept mediocrity in our systems supporting clinical care. And since we accept it, there is little chance of correcting it.

At least I will have lots to talk about with random clinicians I run into on trains.

Provider EHRs

When I consider this whitepaper from Athena Health, I am struck by the fact that Electronic Health Record (EHR) remains such a vague term with regard to the audience. I can't imagine talking about actual instances of EHRs, as opposed to the generic concept of EHR, without regard to the EHR user. I would say that lumping in solo practicioners, small practices and large practices is a bad idea, an example of the fallacy that "if we solve the most complex case, all other cases will work."

This is especially true for clinical lab orders: every EHR is happy to provide menus for the 20% of the catalogue which makes up 80% of the orders. But there seem to be no EHR vendors who want to support the most esoteric, harder to order labs, let alone properly store and display those complicated results.

Worse, the notion of "lifetime results" is also poorly supported; yes, it is true that some small number of years is as long as most lab results are relevant, but what about those tests whose value never goes away? Those genetic tests which we see repeated over and over again?

Someday I would like to see the following:

• Acknowledgement that one size does not fit all
• Full support for lab ordering and resulting
• Full support for lab consults:
• if I have a problem with my Amazon order, I can ask about it
• if I don't understand a lab result, I have no easy way to ask