Monday, February 25, 2013

Pimp my EMR


(EMR Wannabe – Part 4 : Customization)
Robert Rubin once summed it all up in the following sentence: “All of us as consumers have gotten spoiled, ... We expect customized goods and services at commodity prices…The only way we can do that is to cut the fat out of our price structure.”

Damn right. This is the world we’re living in, people. And we, not-so-healthy healthcare buyers of inglorious EMRs, are no different. We consume and we expect, yet the thing is neither customizable nor affordable. And vendors don’t seem to be ready to put their price lists on a diet.
Think about it: if there are so many EMRs out there and if the latter are so equally daunting for users, blame it on their “customizability” index being close to mean sea level. But…wait. That’s not fair. Yes, an EMR is customizable, sometimes, a few things here and there, maybe. Depends…if you’ve got a) plenty of time and b) tons of cash.
It’s like bumping into your EMR vendor on the hospital parking lot after a sales meeting: you’re driving a brownish 1985 Buick Sedan while he just got his initials embroidered on the leather seats of his brand new Porsche. Because I guarantee you that the extras you’ll pay to get the system to fit 10 miserable percent of your basic needs will secure at least 5 generations of Porsche driving in his family.

OK, Nado, don’t let the dollar figures blur your mind. Focus on today’s point. And today’s point is: how exactly do you expect vendors to pimp your ride?

I’m not asking for a Gadgetmobile. I want an EMR that is FULLY AND EASILY CUSTOMIZABLE ON-SITE – not at the vendor’s HQ where geeks will always have something more important to do. Pretty much everything in the system should be Lego-like from the start (as opposed to: the day after hell broke loose), from displays and dashboards all the way to workflows, templates and data tables. Here's what I mean... 

Customizable Patient List
Upon login, Cardios and Pediatrons for instance don’t want to have the entire patient list popping up on their welcome screen. They want to see their patients and their patients only, on a grid that can be configured as they wish since they don’t want to be presented with the same information first. Some might even want to access patient data directly from their calendar, which has all appointments covered for the day.
Data Input: See separate thread.

Can we fax the report here, email the order there, send a copy by mail to the referring physician, cc: Doc Buster on lab results? That’s basic flexibility when it comes to distribution. But more questions shall be asked…and properly answered: How do you make sure this note was read by Fred the Bonehead? How are critical findings brought to our attention? And how do you know that proper action has been taken accordingly by the right recipient? How do you track and audit all that, in all departments – each having its very own ways?

Multiple Signature Support: See separate thread


Customizable Prescription Lists
Hospital prescription lists have 600 000 entries, out of which Cardios typically use 30. Their prescription list should therefore be limited to those 30. Remember Heart Doctors probably love a good time saving feature more than any other doctor out there.

Access Rights and “Need to Know” Factor
When a hospital employee “inadvertently” peeks into Britney Spears’ medical records, it’s a nationwide scandal and we start discussing new measures towards protecting patient confidentiality. But hey, why is it just for VIPs? If I don’t want my hospital-security-guard of a neighbour to peek into my lab results, it’s nothing more than my legal prerogative. But in reality, EMR or no EMR, hospitals are a bit like Spanish Inns right now. Pretty much any employee within the hospital can grab a chart in an EMR as if it was paper – when one should only be granted access to a specific chart if they have a need as a regulatory user to access it. And that requires serious customization leeway backstage. And the “need to know” variable must be factored into the EMR equation.

Order Sets
If I’m a 30-year-old male, the system shouldn’t display pregnancy or geriatrics related options. We want evidence-based ordering features, reflecting the standard procedures for given demographics, departments and healthcare facilities. In other words, the system should never provide me with click-and-make-a-mistake opportunities.
Team Healthcare
Let’s not forget this is where most of the workflow complexity lies. Hence the need for super flexible, super customizable technology. A technology that's able, among other cool stunts, to ensure ALL provider findings are reflected into a single, concise and complete discharge note. Go ahead, impress me.

You probably see where I’m going from here: towards the “one-system-does-it-all” model. Because I am convinced that one system can do it all, provided it is designed with the objective to embrace any scenario and any workflow – as opposed to: just making quick bucks. Sometimes it’s all about the intent.

On the hospital front, that means one vendor, one rep, one support & maintenance contract, one hotline. Plus it reduces the number of interfaces required, which is yet another hidden pain in the mass.


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