Healthcare // Electronic Health Records
Commentary
6/20/2014
10:48 AM
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EHR Proliferation Hurts Physician Workflow

Doctors are being forced to pull data out of multiple EMRs -- plus use phones and pagers -- to care for patients. This context switching slows down work and frustrates the goal of electronic health data.

efficiency, duplicates work, and introduces errors or misses information altogether that might have led to a better outcome.

To address these issues, we need change how we work with the stream of information for patient care. Despite some improvements in EMR technology, healthcare providers still need to search for information in these systems similar to a Google search. Pulling information out of various healthcare data management systems or from different portions of a single EMR takes time away from patients.

The problem is not a lack of technology to allow for data conversion. Medical pros need the simple type of push technology that is used to flag an article on newspaper websites and to receive notifications when a related article of interest is published. In addition, the ability to access related information in a single application or seamlessly move between applications is needed. This will reduce context switching and already exists with smartphones and other mobile computing platforms.

To make this a reality for healthcare providers, a system consisting of multiple pieces is required, but individually, these pieces already exist. To build a more effective and efficient workflow in healthcare requires the integration of messaging with data accessed from disparate and disconnected health databases, all wrapped in a single-view, secure platform, accessible by various smart computing devices.

Solutions available
What is frustrating to physicians is that pieces for creating such a system already exist. One security software leader has developed a mobile security platform that enables secure transmission of data between mobile applications and Web-based storage repositories, including servers, Web pages, and other data portals. Tapping into this platform or other security wrappers will be significant given the sensitivity of the information being transferred. Although secured SMS messaging is available, it needs to be integrated with EMRs and provide push notifications to reduce or prevent the context-switching issues that lead to distraction, inefficiencies, and potential errors.

Beyond the selfish interest of physicians to improve their comfort level, the workflow issue is about patient safety, quality of care, and, finally, bridging the gap between EMRs and better patient outcomes. There needs to be a shift to a patient-centric approach that connects all the points.

We need collaborative EMR systems that work like medical pros and include "smart" analyses that can interpret data. The information needs to be delivered to those who need it, when they need it, all in one place. Add voice-to-text capability to save valuable physician and nurse time and help end miscommunications.

A system that reduces context switching and promotes smart alerting and the pushing of relevant patient information to medical pros will increase patient satisfaction, address quality and timeliness for patients, and allow for more proactive care and patient follow-up.

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Thanh Tran, CEO of Zoeticx, Inc. also contributed to this column.

A board-certified anesthesiologist, researcher, medical educator, and entrepreneur with more than 15 years of experience in healthcare, Dr. Voltz has been involved with many facets of medicine. He has performed basic science and clinical research and has experience in the ... View Full Bio
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Gary_EL
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Gary_EL,
User Rank: Ninja
6/22/2014 | 1:41:20 PM
Re: Growing Pains
Yes, I am interested in working on this problem. I'm not sure if it is proper InformationWeek procedure to put my email address in a comment, so I will contact a managing editor on Monday to find out how to contact you.
don voltz
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don voltz,
User Rank: Author
6/22/2014 | 8:14:44 AM
Re: Growing Pains
Hello Gary,

I completely agree these issues will not be solved overnight. I think instead of continually lamenting about the problems, physicians and other providers need to become part of the solution. Granted, this is not for everyone, but those inclined to put in the time and energy to bring solutions to the market or to the IT folks in a non-threatening way just might help our plight. I fully appreciate the limitations of expanding and customizing the complex EMR's that have been deployed. With our input, reflection on our workflows, and communication of our needs (possibly even bringing other solutions to the table), will help move this issue along. I have been involved in this aspect of healthcare while maintaining a full-time clinical position. Although I am frustrated and feel like we have a huge hurdle to climb, it is my hope that we can collaboratively address the clinical needs and help move the initiative in a direction for the betterment of healthcare. If you are interested in working together on solutions please let me know. The more of us tackling the problem the better. 
Gary_EL
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Gary_EL,
User Rank: Ninja
6/21/2014 | 8:43:02 PM
Growing Pains
Unfortunately, the problems that Dr. Voltz brings up are all too common, and not likely to go away soon. Competing systems do not play well with each other, and medical MIS people have a tremendous task on their hands forging an army out of the various militias, to take an analogous example from today's news. Some hospital system have the size and clout to FORCE the providers to build solid hooks into their part's so that their MIS departments can forge them into a solid working machine. Perhaps the federal government can take the embryo standards developed therein and use them as a basis for a national standard.
Alison_Diana
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Alison_Diana,
User Rank: Author
6/20/2014 | 2:34:43 PM
The Default Position
One approach some hospitals are taking is to standardize on one EMR throughout the entire organization, eliminating the best-of-breed approach that allowed different departments -- say, ER, radiology, and cardiology -- to pick their preferred EMR. While this doesn't address all the issues you raise, it does get rid of the multiple electronic records often associated with one patient. However, many physicians I've spoken to don't like this practice since some EMRs are not well-suited to the intriciacies of specific departments, according to them. They're unwilling to cede EMR control to a central body, which makes buy-in more challenging. 
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