A physician friend and I had lunch yesterday and discussed a broad range of healthcare issues, including the status of electronic medical records (EMRs). (There are a number of EMR stories here in patrickWeb – see list.) USA Today published a story this week written by a doctor who was less than positive about EMRs (see Electronic medical records no cure-all yet). His main point was that filling out electronic forms takes time away from the patient. I have experienced this myself. It is frustrating to sit next to a doctor who never looks at you — too busy entering data. The effortful data entry task certainly takes away from the positive potential of EMRs. Should the healthcare industry do away with EMRs? Certainly not. The balance of this post is about two things: the upside of EMRs, and thoughts on how to fix the data entry problem.
Do we need EMRs? Absolutely. It makes no sense to continue to have the majority of medication prescriptions being scribbled illegibly on a piece of paper and thousands of people dying due to medication errors. It makes no sense to be referred to a specialist and when you arrive you are presented with a clipboard instead of collaboration between providers. Then the specialist asks, “how can I help you?” He doesn’t know why you are there? He has no information about your visit to the primary care physician who referred you to him or her? It makes no sense for heart failure patients to be discharged from the hospital and left adrift with new prescriptions they don’t understand and no follow-up across the continuum of care to minimize the odds of a readmission to the hospital. EMRs address these issues and many more. I am confident that meaningful use will become more meaningful in the months ahead.
How can the data entry challenge be addressed? I see two parts to the solution. First is technological. There are 250+ EMR technology providers. Many of them have systems that were built years ago on old technology platforms. In the payment arena, PayPal has the same problem. It has been around quite awhile and is not built on the latest technology. There are at least a dozen alternatives to PayPal that are springing up that have no legacy and therefore can exploit the latest technologies. It is harder for startups to break in to the EMR market but hopefully competition will heat up and new capabilities will be introduced. One dimension that needs improvement is the workflow of the data entry. Many questions are not relevant to a particular patient or to the particular reason for the doctor visit. EMR software should be smart enough to only ask for what is really needed based on various patient and diagnostic factors. Secondly, EMR data entry should be using voice recognition. The smartphones of today have the power of supercomputers. The combination of better designed workflow and voice recognition should be able to make the data entry process a by-product of a conversation with the doctor. I am optimistic this will happen.
The other factor that can reduce the time physicians spend entering data is to offload much of the data to the patient. Distributors of products used to receive orders on paper and then use data entry clerks to enter the data from the order into computers. Does Amazon have data entry clerks? No, we are the data entry clerks. Amazon offloaded data entry to the customer. ZocDoc has done this very nicely with patients. You fill out your information online. ZocDoc then sends you a reminder of your appointment, and when you arrive the physician staff doesn’t greet you with a clipboard. Even more innovative would be for a system to ask you questions and allow you to enter answers online about your symptoms and bring a preliminary diagnosis to the doctor.
Isabel is an iPhone app that uses a technology called differential diagnostics. You enter the signs and symptoms you are experiencing and Isabel instantly returns a list of possible diagnoses from a database of more than 6,000 diseases. Some physicians cringe at the thought of self-diagnosis, but others see the potential to enhance their productivity by having the patient, with Isabel’s assistance, develop a first pass at a possible diagnosis. The combination of an engaged patient and competiion between EMR providers should lead to a much better way to deploy EMRs as an essential part of healthcare.