Posts Tagged ‘EHR’

Clinical Decision Support in EHRs

September 14, 2009 1 comment

Clinical Decision Support (CDS) systems seem to form a large part of the needs of EHR, a number of physicians seem to have a lot of use for it, but it does not seem to be big part of “Meaningful Use”, at least not yet!

Clinical-decision support gains attention at AMDIS – is an interesting article summarizing this situation. It appears that current Clinical Decision Support systems come in the form of articles released as Best Practice Guidelines or Evidence-Based Medicine articles that are peer reviewed and published. These help physicians help in their Diagnosis and Treatment Plan designs at the end of each visit.

It appears that in Hospitals, they would need actual proof of physicians having used these articles or Clinical Decision Support systems in the form of statistics.

Clinical Decision Support systems, especially, if they incorporate formal studies of treatment or process efficacies, can reduce medical errors and adverse drug events to a large extent. WHO found that if a simple 20 point surgery checklist is followed in every surgery, morbidities and mortalities are reduced drastically. 

Clinical Decision Support systems when combined with EHRs properly stand a very good chance of achieving the now seemingly elusive goal of moving healthcare more towards prevention and wellness rather than illness!


EHR Adoption is Business Process Change: Not Technology Adoption Alone!

August 26, 2009 Leave a comment

EHR adoption or Non-adoption as I see it, is not because of Physicians alone! Lots of other people need to change the way they practice medicine, not just the Physicians!

Success or Failure of EHR adoption is often laid at the feet of Physicians. They are technology-averse, they are not comfortable with computers, etc. However it appears that everyone from the Office Manager or the person at the reception at the practice, to the Nurses and Physicians’ Assistants, to the backoffice billing persons or third party billing companies are all affected by an EHR implementation.

Paper records are so easy to use that not much attention is paid when they are used by these different people during a visit to the doctor’s office. However, when the same practice starts using EHR, you have a single Electronic Visit or Encounter record that gets started up by the person at the front office, the nurse may update the vitals section of this visit,  and then the Physician fills out the rest of the information up to diagnosis, prescriptions or tests to be performed. Then others may take over and complete the rest of the visit and the information goes to billing.

Now you can see that the entire business process needs to be mapped and addressed properly with training for everyone involved. They all need to buy in, be comfortable with the new way of doing things on the computer and start doing all of these in a coordinated manner.

The tough thing is that ANY of these interested parties can cause the failure of the whole system if they do not do their part properly in the EHR but it takes ALL of them to do it properly for it to be successful.

Thinking of EHR rollouts, especially in smaller and medium sized practices as a technology rollout is a disaster in the making! If the whole thing is not considered a fundamental change in the way business is done and then ALL the parties trained properly in doing their part with the EHR, the whole thing will fall apart!

Physicians Use of EHRs – Tug-of-War Between The User Interface and Practice of Medicine

August 24, 2009 Leave a comment

One of the big reasons that Physicians abandon the use of Electronic Health Records is the constant tug-of-war between Physicians’ need to practice medicine Vs getting things done quickly, efficiently and more importantly, completely for accurate billing.

 I loved reading Dr. Stephen R. Levinson’s book Practical EHR – Electronic Record Solutions for Compliance and Quality Care.  Dr. Levinson talks in detail about the various minor things that add up to large irritations on the part of Physicians while using EHR software and at the same time practice their medicine, looking the patient in the eye, asking questions and evaluating the responses!

It is sort of understandable! Before EHR packages, doctors used to talk to the patients without anything like a tablet PC or a desktop or a laptop coming in between them and the patient. This seems like a small thing but seems like a major irritant in EHR usability.  They used to take care of note taking and dictation after the patient visit is over or at the end of each day.

The new way of using an EHR package requires them to change fundamentally, their way of doing their job. That, and the fact that they have limited time for each patient places a lot of stress on the time they can realistically spend navigating the quirks and peculiarities of the EHR package they are implementing!

However, once they get used to the new way of doing things, they have gone over this learning curve and they are converts. One of the Physicians I talked to, had joined a medical practice after they had chosen an EHR package and completed its implementation also. He was ready to quict after two days! But he got used to this package after the third day and now would not do without the same package in other practices he visits!

Interesting tug-of-war between the User Interface and the Practice of Medicine!