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6/7/2011
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EMRs Need Better Usability To Support Improved Care

Most electronic medical records do little more than create an electronic version of a paper chart, according to an exec at a healthcare IT vendor.

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Electronic medical records haven't fulfilled their promise of safer, more efficient, lower-cost care, and won't until usability improves for physicians and nurses and until systems are more interoperable, according to one health IT vendor.

"The objective has got to be to improve the quality of the care," said Rick Kneipper, co-founder and chief strategy officer of business process services firm Anthelio Healthcare Solutions, a Dallas-based company formerly known as PHNS. He noted that recent studies from Rand and Stanford University found issues with the ability of EMRs to improve quality.

"Either EMRs do not help improve healthcare quality as everybody heralded them as doing, or in fact they can't even find a correlation between quality and implementation of an EMR," Kneipper said. "I think you have to take those studies to heart and say something about what we are doing so far isn't working."

Kneipper cited the December 2010 President's Council of Advisors on Science and Technology (PCAST) report that said that most EMRs on the market today do little more than create an electronic version of a paper chart and have little to do with patient safety and quality.

Kneipper, an attorney, believes that developers and implementation teams should be going to doctors and nurses and asking them what they want and need. "I think the reason people aren't listening [to physicians] among other things is they know that the docs are not going to be happy with what's currently being offered because it takes more time, it's more complex," he said.

The $27 billion federal incentive program for "meaningful use" of EMRs, which started this year, may be spurring a lot of healthcare organizations to go digital before they are ready and to accept products that may not meet their needs.

"The Oklahoma Land Rush mentality needs to go away here," Kneipper said. "This is going to be a very big business for everybody for a long time, and it behooves everybody who's participating in this to end up with EMRs that do indeed deliver on the promise that Congress and everybody thought they would deliver at some point. Let's not rush to rack up a lot of revenues in 2011 if everybody can do a better job by waiting until 2012 or '13."

He also wants the government to demand more from providers, and sooner. "I see them backing off continually on giving more time and lesser requirements to meet," Kneipper said. If he were in charge, he would emphasize interoperability. "I'd say interoperability has to come really soon. And people will say, 'We can't do it,' all right, we just don't get EMRs to happen as quickly, but then we're going to get them to happen the right way.

"There's no silver bullet, of course, but I think interoperability is a critical one. I think that's really important if you're going to provide a fully integrated set of patient information that follows the patient wherever he or she goes."

Another key element is clinical decision support. Stage 1 of meaningful use requires just one rule for clinical decision support, down from five in an earlier proposal. Kneipper said that physicians often tell him that they have lots of data, but nothing they can act upon, even though many EMRs provide reporting capabilities. "But reporting isn't data analytics," Kneipper noted. "Lots of docs are doing the proverbial 'Where's the beef?' here when they get electronic forms."

Kneipper also cautioned against EMRs being implemented as technology projects rather than quality improvement projects. "If it's a quality improvement project, the people that are going to be involved are not the techies, but the physicians and the hospitalists and the nurses and the clinicians, and they are going to be talking about how do we improve quality, how do we improve patient care, how do we improve the efficiency of the whole process. You're going to get a vastly different result if you do that," he said.

"There's a huge amount of opportunity here if it's done from the point of view of the clinician."

The Healthcare IT Leadership Forum is a day-long venue where senior IT leaders in healthcare come together to discuss how they're using technology to improve clinical care. It happens in New York City on July 12. Find out more.

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