All Things EMR | Ideas & Research
Our Brave New World: EMR and The “Ownership” of Health Information
At the HIMSS 2012 conference in Las Vegas this past February, Dr. Farzad Mostashari, National Coordinator of Health Information Technology, observed that while there is still a lot of work to do on the adoption and use of electronic medical records (EMR), the majority of physicians in the US will be using an EMR within the next two years.
And we like that. It shows progress.
It also means we are experiencing an acceleration of the paradigm shift from the “Old World” of paper-based health records to the “New World” of EMRs.
None of it feels like a small adjustment; more like a tectonic paradigm shift for the health care industry. Even as the Old World recedes around us and the New World emerges, Old World concepts of health records and record ownership do persist. They manifest themselves in some unusual ways, too, and with surprising staying power, persisting in laws, regulations, the way we think about records, the way we do business and, often, even in EMR offerings themselves.
EMR systems that have not fully transitioned to the new paradigm represent a “Middle Path” that slows down change and innovation. To move forward successfully from the Middle Path to the New World, we will ultimately need to resolve the conflicts between the paradigms.
Ownership vs. Use
So, what about these conflicts? In the Old World, records are regarded principally as physical items–paper files that contain information. Therefore, the Old World focuses on custodianship of the record, which then translates into the question of who “owns” the record and, therefore, the items (information/data) contained within the record. This is a property-based approach to health information. In the New World, the interest is the data itself and, more important, aggregated data across multiple records that:
- provides meaningful insight about what care protocols work
- enables caregivers to communicate better with patients
- enables researchers to more expediently identify patients to participate in studies
- achieves better public health reporting and analysis, among other uses…
Therefore, in the New World, how the data can be used and how it can be leveraged is more relevant than who owns it.
Are you still living in the Old World? Did you make the leap to the New World? Tell us about it.
Next week, we will explore static records vs. real-time records and ways that software-based EMR systems often represent the inertia of the Old World paradigm.
Old world: document everything w pen/paper. Eye contact w patient. Dictate initial encounters and consults, or important follow up visits. Dictate reports. Send copies to referring providers and patients/families of patients
New world: click, click, tablet in the exam room, wait for the screen to change, click, wait for the MRI image to load, click, don’t drop the tablet, try to get the stylus handwritten recognition software to recognize a medication name, click, dictate w/dragon, type, click, correct dragon… A lot. Do a first time e-prescription and get a call back that it arrived illegible or incomplete. Or it did not arrive.
Work with the autogenerated “letter” to make it sound “human”
Middle Path: so you say the middle path slows down the process… OK, here is the middle path. Take paper to the exam room, be present, have a normal encounter. Fax the soap. note to athena, dictate a normal consult note, have it transcribed, fax the nice consult report to athena and the referring doc and the patient. Go to gym, have a life, pay the transcriptionist, pay the coder, pay the data entry medical asistant, write an Rx, and do the e-prescription for a refill when it is already in the system.
So for me, the middle path is a path to have the closest thing to a normal life, don’t make it sound like us middle pathers are sabotaging the glorious EMR movement. I do what I have to do in order to see my patients (not as many as before, but some of them) and get paid (not as much as before, but some) and have a life (… Not as much… Well, you get the point)
Perhaps I need to get a little better at thie EMR thing, but perhaps the EMR thing needs to get a lot better at interacting with a human and make it look human to the next human that has to work with the product, because at the end of the day, the product is the delivery of care, and a meaningful document that conveys… Not just a document that can be billed.
So we all have to give a little
Until athena comes up with better ways to export the clinical data, athena users cannot achieve most of the “New World” advantages listed above. While we can probably communicate better with patients, there is no ability to aggregate clinical data down to the level needed to make meaningful decisions based on findings documented in the history or physical examination. While athena allows us to document findings discretely in these sections, it is impossible to extract them locally to look at population variations or changes in a single patient over time.
FP in private practice. My experience: I’ve been using the athenahealth EMR for about 18m and I think there is more and better contact with the patient than before. I rarely keyboard in the room – most of my charting happens after the visit, in between patients. Before the visit I can flash through all the labs, see what I did last time, and see what sort of quality indicators I might try to weave in. In the room I might look at labs and flow sheets with patients, but i don’t have the dead air experience of being buried in the pages of a chart looking for stuff I can’t find.
It takes a while to find the stride but in the long run I am convinced the experience and quality for patients goes up.
First of all, thank you for the thoughtful comments! While I was trying to address the legal and regulatory barriers to realizing the full potential of EHRs, no doubt that there are usability challenges in EHRs as well, including athenahealth’s, and working on getting to a better place is a process. Check out this post from our VP of User Experience Mary Kate Foley discussing the usability challenges and how athenahealth is addressing them. With our clients’ input, we plan to chip away at these issues and bring about a better patient encounter experience. On the legal side, we are working to remove barriers to information exchange and to preserve the flexibility to meet the usability challenges in innovative ways.
Thanks again for reading and taking the time to comment.