Aug 22, 2007

My view on Electronic Medical Records - EMR

I have read a lot about EMR systems, but I never really saw one. I imagine they handle appointments and allows staff to maintain a patient database. Maybe the more advanced ones electronically transmit data to insurance agencies and pharmacies and get lab results.

But I wonder if they actually help the doctors at all. I suspect they are just electronic notebooks for doctors having them enter notes electronically instead of dictating them.

I wonder if the lab results and other documents are stored in the database as searcheable numbers or they are simply pictures of the other documents.

I imagine that a good EMR should allow the doctor to select options from lists of values and then generate codes and reports. I looked at my doctor's notes once. He started by dividing the sheet in 3 areas and labeled each with the subject he needed to cover. It could have been Chronic hypertension, right upper quadrant pain and heart (I'm making it up, I don't remember the details). Anyway, it would be nice to have a program where you just enter a few letters and it fills out the rest. If you have a category that is not in the list, you can enter it in a separate field and the program should be smart enough to "learn" it and use it next time.

Then, because hypertension was selected, it would open up a history of that and give the doctor options. The computer should suggest a billing code, but allow the doctor to modify it. It should give medication options and allow the doctor to pick one.

When done, it should generate any report that is needed: referrals, letters to other doctors, insurance papers, etc. and allow the doctor or staff to review it one more time before sending it electronically.

Is this what EMRs are about? I doubt it. I am building database software systems and I am very aware how difficult it is to build something with such high level of artificial intelligence, but if they don't do all that, why would we be surprised that doctors are slow to adopt them? What do they bring the doctors? I think that the existing systems are more about keeping the office lean (less staff) than actually helping the doctor.

Why am I writing all this? What a good question... I guess because I am dreaming to build such a system, but I see few chances to get there.

1 comment:

Andrew said...

Hello Ileana,

EMR systems are so troublesome to some and to others, it might be a blessing. I know that with my boss, who happens to be an internist, he loathes it. I am not quite sure if we had made the right investment with an EMR system. It woudn't have mattered which system we would have purchased because in the end all systems require that the physician type up the progress notes of patients. Considering that he may see up to 25 - 30 patients a day, this task has become a nightmare for him. I am almost in despair because he blames the entire business for this mundane task. My recommendation is creating a series of templates that a physician will be able to easily check off as he or she reviews the organ systems. If the doctor needs to add any extensive notes, then sub-templates can be chosen or pop up to enter those notes. That's a start but I do not know how to proceed once the physician has to review the charts....