Medical Software Brings Intuitive Interface To Health Records - InformationWeek

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4/3/2014
10:26 AM
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Medical Software Brings Intuitive Interface To Health Records

With a 3D anatomical model on the iPad, Modernizing Medicine taps the power of touch to simplify electronic health records and medical coding.

the cloud-based software. There is also a browser-based version, meant primarily for office staff or doctors to use in a pinch, when the iPad isn't available.

The visual approach is something doctors didn't know they wanted until they saw it, Cane said. They tended to ask first for an electronic equivalent of their paper charts, which is what many other EHRs give them.

Unlike other EHR software products that were developed as extensions to hospital billing or practice management systems, Modernizing Medicine's EMA is EHR-only. "We're a bit of a unicorn in that respect," Cane said. Yet by deciding to integrate with practice management systems rather than duplicating their work, "we turned hundreds of potential competitors into partners," he said. For example, Athenahealth and CareCloud win customers more for their ability to help customers with claims processing and collections than for their EHR software, and they can accommodate EMA as an alternate front end for recording data from a patient visit. "As long as I don't compete with them, they will send me business," Cane said.

Similarly, his approach to the hospital market is not to compete with enterprise EHRs like Epic but to position EMA as an alternate front end that specialists can use to capture data from patient visits and feed it into the enterprise EHR.

Meanwhile, the reason physicians choose EMA is that it's tailored to their specialties. Sherling, the firm's chief medical officer, says most EHRs are too generic, like word processors that can be used to type any message rather than being customized to how a physician practices medicine. "All these word processor EHRs are designed with a lowest-common-denominator, one-size-fits-all methodology," he said. Doctors are not all the same, "but we're being treated like a commodity," he added.

"Doctors themselves -- we just want to treat the patient," not futz with technology, Sherling said. The goal of EMA is "almost to take the doctor's brain and put it into the software itself."

In addition to hiring doctors in the specialties it targets to help with software design, Modernizing Medicine uses adaptive learning technologies Cane brought with him from the educational software industry. In this case, the software is learning how the doctor practices so it can make intelligent recommendations. "We use predictive analytics to speed things up and save them time," Cane said. That means the drugs a doctor prescribes most frequently for any given condition appear at the top of the list in the e-prescribing module. Ditto for lab orders, or ordering the instruments and anesthetics that should be on hand for surgery. Most everything is a drop-down list. Although physicians always have the option of typing in a note, the goal is to anticipate their every move.

"Doctors not only can't type, but if you give them virtual keyboard, they really can't type," Cane said. "Instead, you need to think of something that's like the order-entry system for a fast food restaurant." Since medicine is more complicated than flipping burgers, the menus must continually change to present the most relevant choices for a specific clinical setting. "The system understands the domain, because the physicians taught it to them," he said.

Medical claims coding is simplified because EMA captures structured data rather than unstructured notes. Some other EHR systems are trying the opposite approach where natural language processing is used to extract structured data from free-form physician notes and generate ICD-9 or ICD-10 codes on that basis. Cane said it's much easier to translate structured into unstructured data than the other way around. For example, EMA will automatically generate a short narrative based on the data the physician (or his assistants) recorded -- the same information in paragraph form about the patient's complaint and the treatment administered. That's easier for doctors to scan than a database report, and it also gives them the opportunity to add any further notes that might be relevant -- by typing or using medical speech recognition software -- where their observations do not fit in any pre-defined database field.

The next frontier for Modernizing Medicine is analytics -- ultimately, Cane said it will be more about analytics than EHR. Already, EMA taps data gathered from all users to help doctors with their decision making. If a doctor doesn't know what to prescribe for a given condition, he can see what his peers from across the EMA customer base prescribe under similar circumstances.

Even more bleeding edge is a forthcoming "Ask Watson" service produced in partnership with IBM, which will come to market as an add-on or upgrade (details to be announced in the coming months). In the prototype Cane

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David F. Carr oversees InformationWeek's coverage of government and healthcare IT. He previously led coverage of social business and education technologies and continues to contribute in those areas. He is the editor of Social Collaboration for Dummies (Wiley, Oct. 2013) and ... View Full Bio

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dcane
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dcane,
User Rank: Apprentice
4/7/2014 | 10:03:27 PM
Re: Could Modernizing Medicine's approach be taken further?
We've heard repeatedly that one size fits all EMR systems don't work for specialists, who have very distinct needs that most enterprise EHR systems don't address. Employing practicing surgical specialists to develop our system is not an inexpensive venture, but it is a wise investment. But the fact of the matter is that very few physicians work in silos, and the need to share patient information to best serve the patient is a growing necessity. So, we realize the need to make it easy for physicians to quickly and accurately document patient care while ensuring the data is usable by other healthcare providers in an enterprise system.
David F. Carr
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David F. Carr,
User Rank: Author
4/4/2014 | 10:10:15 AM
Specialized EHRs for Specialists
Aside from the use of the iPad and the 3D anatomical model, one of the distinguishing characteristics of Modernizing Medicine's EMA is that it targets specialists, and specialists tend to prefer an EHR that is tailored to their needs over any enterprise system that is more generic.

I pulled a couple of clips from our archives to back this up.

Physicians Prefer 'Best Of Breed' Emergency Department EHRs - InformationWeek http://bit.ly/1luuPqC

EHRs Aren't Specialist-Friendly Enough - InformationWeek http://bit.ly/1lFFUaZ

CEO Cane points to a possible compromise, which is having EMA function as the specialist-friendly front end user interface grafted on to an enterprise system like Epic that organizes data at the hospiital / health system level. A somewhat similar hybrid approach for viewing rather than recording charts turned up in this story: UPMC Tablet App Speeds EHR Access.

Maybe instead of best of breed vs. enterprise EHR, the best answer is best of breed + enterprise EHR? The enterprise view is important, but so is the productivity of the physician.
David F. Carr
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David F. Carr,
User Rank: Author
4/3/2014 | 11:14:59 AM
Could Modernizing Medicine's approach be taken further?
Modernizing Medicine is probably wise to focus on specialists, rather than competing in a crowded market for general-purpose EHRs, but can you see this visual approach being applied more broadly?
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