Healthy Living Dealing Amongst Ehr Dissatisfaction (Part 1)

For the yesteryear few days, I’ve been involved inwards a really goodness conversation at LinkedIn HIMSS titled: Can nosotros plough EHR dissatisfaction around?

Here’s a comment from mortal that struck a chord:

It took the Dr. 2 minutes to dictate every bit opposed to thirty minutes to purpose speech, edit and/or type. In addition, if the text is non edited inwards almost cases except for those of y'all convey it downward perfect, y'all larn crappy documentation that is (oh my goodness) truly used downward the route to care for a patient. I tin also innovate y'all to several police suits filed due to the hapless documentation of a physician who refused to edit his dragon speech communication as well as but allow it locomote into the chart. I tin also innovate y'all to a neurologist who spends 4 ADDITIONAL HOURS a twenty-four hours documenting inwards an EHR. He has been at it for over a twelvemonth hence plainly this encephalon surgeon is an idiot who can't endure trained. All of your responses to this, fifty-fifty the "this is off topic" are really revealing every bit to i rootage of the problem. Like typical programmers, no i wants to remove heed they convey a bad pattern or the production truly needs to a greater extent than work.

So, to remain on topic, "Can nosotros plough it around?" yes but solely when y'all brain to the experts inwards the land y'all are dealing with - medical tape specialists as well as physicians - they look to endure the people y'all convey left out of the equation.

I'm a clinician (clinical psychologist) as well as HIT software inventor/architect/developer with 33 years’ sense inwards both areas. What I've noticed is that programmers routinely rely on healthcare bailiwick affair experts regarding production content, the same is oftentimes non truthful regarding workflow adaptation, usability as well as usefulness issues.

It's relatively slow to create databases as well as forms for information entry as well as presentation, but it's quit hard to build the inputs as well as outputs inwards ways that streamline workflows, integrate as well as organize complex interdisciplinary information inwards clinically meaningful manner, generate clinically useful information that supports decisions at signal of care, as well as acquaint that information inwards ways that promote noesis as well as agreement that Pb to greater value for the consumer/patient.

Herein lies the problem, imo, as well as it is where disruptive conception is sorely needed!

Unfortunately, such creative destruction is oftentimes hindered yesteryear governmental regulatory capture inwards which large bucks straight the regulators who dictate the rules that constrain innovation, focus on appeasing large business, as well as campaign upward complexity as well as cost.

A brusk patch later, Randall Oates, MD posted a comment that ended with:

It is fourth dimension for to a greater extent than enlightened physicians to footstep upward as well as assist/collaborate the transitions to processes generating EHR notes that are to a greater extent than clinically useful, patch coming together basic billing/legal/reporting needs of others every bit well. Otherwise, physicians convey to mainly blame themselves for systems that don't catch their needs.

To that I replied:

Randal, I'd to add together to your first-class statement: "...and present, inwards a concise integrated view, the relevant interdisciplinary information needed to back upward their clinical decisions, at signal of care, that is focused on continually improving outcomes as well as tending value.

For yesteryear twelvemonth as well as a half, I've been volunteering my fourth dimension inwards a Federal workgroup (WG) called the 360X maiden as well as function with Cerner, Epic, as well as several other large EHR vendors as well as HIEs on implementing closed-loop referrals. In the WG, I'm a "little guy" offering new ideas as well as methods to the "big guys."

I sincerely believe that the clinical as well as technical folks inwards the workgroup create desire to better their products, despite the fact that I convey had to repeatedly insist that instead of focusing on doing the minimum; nosotros focus on dealing with the big, complex issues, specially regarding workflows.

I'm also involved inwards several other Fed workgroups that create HIT meaningful purpose standards. What I've noticed is a full general style to proceed things complicated, patch at the same time, minimizing the reach of their efforts. Many times, when I’ve tried “push the capabilities bar” higher--and fifty-fifty offered innovative ways to create it)--I’ve heard the phrase: “We should get-go crawl as well as hence walk earlier nosotros essay to run.” Unfortunately, after all these years, when it comes to enhancing EHR systems' clinical usefulness as well as security, there's likewise much crawling nether the "low bar," as well as a full general aversion to trying to "leap over the high bar."

I believe at that topographic point are many reasons for this as well as they to a greater extent than oftentimes than non relate to the “business layer” supported through regulatory capture yesteryear HHS/ONC.

After 3 decades of HIT involvement, I’ve come upward to the conclusion that what nosotros postulate is to transform EHR products into “EHR systems” (a term I helped add together to the Fed’s dictionary as well as workgroup charters). These EHR systems would endure enhanced through integration with depression cost, easy-to-use “companion applications” that create total inwards gaps inwards EHR usability, usefulness, interoperability, as well as protection of PHI.

The companion apps are probable to endure disruptive innovations created yesteryear loosely-coupled collaborative networks of pocket-size nimble companies as well as individuals with various backgrounds as well as experiences, who share, discuss, evaluate, as well as continually evolve models (types of apps) focused on dissimilar purpose cases as well as types of end-users.

 [Continued inwards Part 2 at this link]

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