Friday, July 30, 2010

What Doctors Want in An EHR - It Would Also be Good For Patients!

I thought this was a really useful contribution from one of the Gurus

Perfecting The E-Health Record

Decision support, event-driven alerts, voice recognition, social networking--the EHR of the future should have it all.

By John D. Halamka, InformationWeek
July 24, 2010
URL:
http://www.informationweek.com/story/showArticle.jhtml?articleID=226200059

The federal government is spending nearly $30 billion on electronic health records to improve the nation's healthcare. If I had infinite resources and time, and a greenfield for innovation, here's how I'd design the EHR of the future:

Physicians are on call round the clock, have to be in many different places, and use a variety of computing devices. Therefore, the ideal EHR would be Web-based, browser-neutral, and run flawlessly on every operating system.

It would incorporate decision-support tools and patient-specific preventive care reminders. And it would provide event-driven alerts that send critical data to doctors when immediate action is needed, such as when a patient on digoxin has a low potassium reading that increases the likelihood of dangerous changes in heart rhythm and other toxic effects from the medication.

The EHR would have an easy-to-read summary of all the patient's active problems, medications, visits, and labs. This summary would be exportable to personal health records, such as Google Health and Microsoft HealthVault.

Caregivers would pick from standard, predefined terms to describe patients' problems, and all the patient's clinicians would use specialized social networking tools to collectively maintain these problem lists--a kind of secure Wikipedia for the patient.

An e-prescribing app would link directly to payers' formularies so that doctors would know which medications are covered. It would determine eligibility for high-cost therapies in real time, link to a patients' medication histories, and check for drug interactions and allergies. A pharmacy-initiated workflow would reduce calls to physicians for refills. Here, too, the EHR would use social networking to let caregivers update, change, and comment on patient medications.

Patient visits would be documented with the reason for the visit, the diagnosis, therapies given, and follow-up expected. Notes would be entered using structured and unstructured electronic forms. All data would be searchable. Disease- and specialty-specific templates and macros would make documentation easier. Voice recognition would allow for automated entry of recorded notes. Workflow for signing and forwarding notes to other providers would be easy to use.

.....

At Beth Israel Deaconess Medical Center, we've already achieved much of this functionality. But we'll never be done, because the perfect EHR is a continuously evolving target.

Dr. John D. Halamka is CIO of Beth Israel Deaconess Medical Center and Harvard Medical School, chair of the New England Healthcare Exchange Network and the U.S. Health IT Standards Panel, co-chair of the HIT Standards Committee, and a practicing emergency physician. Write to us at iweekletters@techweb.com.

Do read the whole article to see all the other ideas as to what is needed.

Can I say if we could get to having what John is talking about here for all Australian clinicians the job would be near enough to done.

Both Government and Commercial providers could safely use this list to navigate a way forward.

I wish!

David.

9 comments:

Blog Phan Xuân Trung said...

In Vietnam, we have 95% of these ideas". These features have been done since 6/6/2006 at the An Khang Clinic www.akclinic.com.vn
We don't have sound recognition because it is not suitable for Vietnamse language.
I hope to see David soon to show these features. I hope to come to Autralia to talk about this.
Now you can see some demos at http://htmedsoft.com/clips/demo_flash.htm
You can use google tools translate to see the web in English.

Terry Hannan said...

I can recommend reading and the measurement of success at http://openmrs.org/wiki/Summary_of_OpenMRS_Implementation_Sites
Many of the core fucntions John defines have already been done and work. A major cultural chnage is required across all levels of the e-health process particularly at the "clinician" levels (not just docs) Terry Hannan

John Johnston said...

So many of the good bits of an EHR that John Halamka describes is already available in Australia. To take what we have through finishing school requires collaboration, a belief that a range of eHealth vendors in private enterprise actually have the bits, some guided democracy to drive vendors towards a specific goal and a little more investment from Government to aid that process.

Anonymous said...

John Johnston says "To take what we have through finishing school requires collaboration".

As no one party is an expert in everything it should be obvious that collaboration of some kind is the way forward. As vendors we have been talking about 'collaboration' for eons. In fact without it nothing much will happen. So the issue surely is what form should that collaboration take? Various models have been tried and failed. What kind of collaborative model do you have in mind?

Dr David More MB, PhD, FACHI said...

I think the major think that is missing is a genuine functional certification scheme that is open, transparent and fair and sets a minimum but progressively rising bar for the capabilities and utility provided to clinicians and patients.

The US has such a scheme and it could be made to work here I believe.

David.

Anonymous said...

Certification smacks of bureaucracy and I am far from convinced that the act of certification alone will be of much value let alone be enforceable in a free competitive market environment.

Collaboration sounds like a better option but some of the issues are who will fund it, who will take the risk, who will own the outcomes and what is the likelihood those who set out to collaborate in the beginning will still be doing so at the end?

Dr David More MB, PhD, FACHI said...

Funny then that it actually works in the home of free enterprise and competition - the USA.

The evidence for effective collaboration actually happening in OZ has been pretty thin on the ground - As seen by the difficulties the MSIA have had in getting collaborative projects up and running.

Sometimes an independent expert certifier can help the industry advance.

David.

Anonymous said...

The MSIA is riddled with too many vested interests emanating from competitive entities that comprise its membership base for it to be a healthy 'environment' in which to collaborate. Past attempts have proven that to be a fatal path to follow. There must be a better option.

Anonymous said...

Sunday, August 01, 2010 1:31:00 PM whatever you might think about MSIA is of little consequence if you pause for a moment to analyse the issue under discussion - which is 'collaboration'.

For example "John Johnston says "To take what we have through finishing school requires collaboration"." He did not specify however what he meant by 'collbaboration' and 'Who he thought should be collaborating'.

You have assumed he meant the vendors should be collaborating hence your reference to MSIA. But there was no suggestion MSIA should be the lead 'collaborator' - indeed far from it because their membership base is the wrong place to start. So, although I can agree with you on some points you were wrong to introduce MSIA into the discussion in the first place.

True collaboration in health research is common place and it works well. By comparison however, true collaboration in healthIT is very rare. The reason is because the healthIT vendors are the wrong place to start when addressing the problem. Few seem to understand how to build a collaborative environment which will work.