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May be an EMR that looks very different from current paper or electronic systems.

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EMR CLICKS“Clicking takes much longer than flipping.” And that is why electronic medical records should be redesigned to be more efficient. EMR systems do not take full advantage of the organizational functionalities, search proficiencies, or visual capabilities of computers. Doctors are comfortable with paper charts, because they can be reviewed so easily. Lab results, for instance, are often printed and clipped to a paper chart, so the physician can quickly review the results and look at the last note or compare them to old results by simply flipping through a few pages. “A lot of analysis and scanning is going on during this process, but it is all at virtual speed in the physician’s brain,”. The physician finishes the review by initialing the front page of the results, writing or stamping an interpretation on it, and putting it into an outbox for an assistant to complete and file.

“In a typical EMR scenario, however, the same workflow may take much longer because each step requires extra clicks and scrolling,” Dr. Berkowitz continues. The physician must first execute a series of clicks to reach the results section in his or her EMR. Then he or she may have to click several more times if the results for various tests are grouped separately for the same patient. And if the results section does not clarify whether the tests are finished or pending, the physician will have to go through another series of clicks to verify that all orders have been completed, Dr. Berkowitz says. Additional clicks may be necessary to access a flow sheet that allows the physician to view past lab results and compare them with current results. Then the physician must document what he or she will tell the patient and the method of notification by clicking to access another page and typing in the information. “Finally, even more clicks are added if the physician decides to write something in an electronic sticky note so the information is readily available for the next patient visit,” he adds.

“This is quite simply a waste of our time,” Dr. Berkowitz says. This workflow process may even hurt quality, he continues, since a physician’s analytical thought process will be interrupted by the effort of repeatedly clicking to access information from different areas of the EMR.

So how to solve this problem?

“Create a system that gives the physician everything they need in one place and that emulates the thought flow they use to make a decision,” Dr. Berkowitz says. The EMR system should have a “results dashboard,” which would allow a physician to immediately visualize lab results, prioritize them, and act on them. The physician should be able to quickly clarify which test results are completed for each patient and which are pending, perhaps by holding a cursor over a designated area or having a color-coded icon appear next to the patient’s name, Dr. Berkowitz explains. A second color-coded icon could represent whether results are normal or have minor or critical abnormalities.

EMR systems could also help prioritize lab data by comparing the test results to normal ranges or weighting certain tests as more important than others, or both, he says. For example, a hemoglobin abnormality would be weighted as more important than a chloride abnormality. “The result is that the EMR has helped the physician easily see how to prioritize the results—all with no extra clicks,” Dr. Berkowitz says.

Furthermore, a physician should be able to click on a patient’s name to see—all at once—current and old test results, current medications and diagnoses, and perhaps even a summary of the most recent office visit. Rather than appearing as numbers, the test results might appear in graphical format, making it easier to put such data on one easily accessible page, Dr. Berkowitz says. This expanded results dashboard, he continues, would also allow the physician to sign off on lab results, choose the appropriate interpretation (normal or abnormal results), and make a notation of the next step, such as notifying the patient, changing a medication, or scheduling an appointment. “And, of course, performing any of these action items creates automatic documentation that is recorded in the chart,” he adds.

So how to get there?

Vendors need to view workflows not as individual tasks, but as a series of related tasks combined with thought processes that allow users to interpret data, draw conclusions, and make decisions, Dr. Berkowitz says. And they need to pay more attention to the wants, needs, and frustrations of their current clients, rather than focusing on the requests of potential customers who use paper-based systems.

Also shaping the future of EMRs are organizations such as the nonprofit Szollosi Healthcare Innovation Program, of which Dr. Berko­witz is program director. The orga­ni­zation is “creating prototypes of new user interfaces to help stimulate vendors and others who are developing the EMR systems of the future,” he says.

The end result, Dr. Berkowitz concludes, may be an EMR that looks very different from current paper or electronic systems. “This may be scary for vendors used to showing physicians something that looks familiar,” he says, “but vendors will be much more successful if they can move away from the paper-based paradigm and take real advantage of computers.”

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Last Updated ( Wednesday, 18 June 2008 02:50 )  

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