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A Call for Intuitive EMRs

 |  By smace@healthleadersmedia.com  
   July 24, 2012

I've previously remarked that software can't do it all—resolve all antiquated workflows or figure out stumbling blocks in people and politics. Unfortunately, that's just what EMR software is about to be asked to do.

Software is a funny thing. Done well, it anticipates the needs of human beings, or other software, and responds in flexible, flowing harmony.

Done poorly, software epitomizes everything wrong with modern society: impersonal, inflexible, regimented, mundane, boring, even maddening.

Where does your electronic medical record software wind up on that spectrum? Chances are, it doesn't look so good in comparison to your searching experience on Google or your shopping experience on Amazon.

"We need the EMR that's going to intuitively know the way our physicians practice and know the difference—and not every time a physician wants a change, we get a call, and we say we'll take that to the team, and the team will analyze it, and then the team will take it to the programming team, and in about a month, we should have your change put in our system," says Pamela G. McNutt, senior vice president and CIO of Methodist Health System in Dallas, Tex.

"'EMR 2.0,' as I call it has to be intuitive. It has to adapt to the physician workflow without an army of 200 people in IT behind it trying to change the code," McNutt says. "That is not a sustainable model for us to have that many people behind the scenes creating all these boxes and screens. It has to be intuitive but we're all busy dotting I's and crossing T's.

"Even the 'Cadillac' systems for physicians and hospitals are nowhere near EMR 2.0 that I envision for the future," she adds.

McNutt hopes for some "dark-horse" software from an as-yet unseen vendor, maybe from Europe or sitting in some incubator deep inside MIT, to leapfrog the capabilities of current systems. "I could make a fortune if I could figure out who this is that's going to do that," McNutt says with a laugh.

Unfortunately, software innovators—the Amazons and Googles—only come along once in a great while. Healthcare CIOs appear to be stuck living with our current generation of imperfect software.

Another option kicked around, even more unrealistically, is to hope that clinicians adopt some kind of standardized workflow. That would help software immensely, because today's software has been constructed with layer upon layer of options to accommodate different workflows. This complexity in turn adds to the complexity of the software, of training for the software, and of trying to keep the training for the software inside one human head once training is completed.

But I don't see any standardized workflows on the horizon. Nurses in two departments of the same hospital often don't have the same workflow for administering medication. How can an entire healthcare industry be expected to standardize workflows?

The free market has its own way of imposing standardized workflows on healthcare. It's called mergers and acquisitions. But each merger or acquisition brings even more risk to the endeavor, as executives strive to merge two workforces. More massive consolidation also means a lessening of responsiveness to local market conditions.

The media, myself included, subtly encourage the big getting bigger, guilty of paying more attention to the largest healthcare systems, where ample money and resources permit early and well-planned adoption of the latest and greatest technology. But those systems "live in rarified air differently than we do," says Charles E. Christian, CIO of Good Samaritan Hospital, a 237-bed hospital in Vincennes, Ind., serving a 10-county area of 250,000.

Christian is working on Stage 1 of Meaningful Use. "I won't attest [for Meaningful Use] until September of this year," Christian says. But rather than feel a sense of accomplishment at that point, this rural hospital instead faces the starting gun of reaching attestation for Meaningful Use Stage 2. And it is daunting. Final rules are now expected at the very end of summer or even a little later.

"It means that I've got only about 12 or 14 months to learn what the certification requirements are, get my vendor to install software, and have it ready to go by October 1, 2013," Christian says. "I hyperventilate just to believe that, because I realize what that requires. But don't think that's just a tiny issue for community and rural hospitals. I think all of us in healthcare, even the larger systems" feel the pressure.

No one will feel that pressure more than physicians being asked to do even more than they do today. Even when they learn how to navigate all those new check boxes and unintuitive workflows, they may still be using software that hasn't been adequately tested.

"Just because we get rules out today doesn't mean the vendors are able to generate code tomorrow and get stuff out to implement," Christian says.

For now, expect the entire healthcare profession to lean even harder on the current software industry, with all its faults and shortcomings, to perform miracles. Given the massive amounts of money flowing from government to provider to vendor, it shouldn't be too much to ask.

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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