If I Were a Doctor … EMR

If I Were a Doctor … EMR

Several doctors I know have asked me for advice on buying an Electronic Medical Records (EMR) system. Here’s my advice:

Start with a network of other doctors in your specialty. You don’t have the time to do all the research and evaluate all the options on your own. You will also need that network after you purchase the system. An ideal network for this is probably between three and six doctors. If a doctor you know has an EMR that she likes, start there and then check the rest of my recommendations.

A network will give you better points of view and more resources to make the buying decision. If a vendor knows that a sale to one will probably lead to a sale to several they will work harder at assuring you that the system meets your needs. They will also be more willing to consider changes or enhancements if that will lead to multiple sales.

After the sale, there will be issues. If several of you have the same issue, you are more likely to get prompt vendor attention. If the issue can be solved by training, your staff can work with staff from the offices of the other doctors to share what they know. For this reason, I would bring the person in my office who has the best attitude toward computers with me to some of your network meetings and suggest that others do the same. Computers can make people feel very stupid. It helps if you can call someone you know for help or take a call to give help.

Get the service via the Internet. You will have to have computers in your office but data will be stored off-site, problems can be addressed remotely, and system will be kept current. A vendor will provide redundancy (backups), secure storage, and should have better general security than on a stand-alone system. HIPAA and other regulations are applicable.

Insist that all programs are written in one of a number of common programming languages and data is stored and accessed using SQL. If you need to migrate to a new system – EMRs are still in their infancy and change will happen – it will be easier if everything uses standard parts and solutions.

Listen for flexibility when the vendor talks about the system. There are new products coming, think of the iPad. Google Health and Microsoft Health Vault are adding features and functions. Your patients are using the Internet to make better use of their time; they will expect you to support that. Simple example, have the capability to post your reports on their personal health records so they can share them with other doctors so they don’t have to take the same test over and over. Sometimes this will be with doctors who do not even have systems and you probably don’t know. Today, that takes several phone calls and a FAX or two. Way too time consuming. They also own the data and you need to help them use it responsibly.

Expect online help to come with the system. Your staff should be able to learn to use the system with a combination of basic computer skills plus online documents on the system. Not the best way but you can’t send every new-hire off to a class and routines that are not used get forgotten. Example: Change a patient’s name when they get married so the old and new records are continuous? Add a new doctor to the practice? Change a staff member’s password?

Have one doctor’s office install first and check it out. With orders waiting in the wings they will get better service and all of you will get to watch the system and the vendor in action. Send the person in your office with the best attitude toward computers to sit in on some of the training sessions and to get some practice. Get the administrative parts of the system stable in each office before the doctor’s in that office start to use the system. It is easier to fix administrative records and staff downtime is less expensive than doctor time.

No guarantee of success or satisfaction, but that is always true with computer systems. These steps will improve your odds of getting a system you and your staff will like and find useful.

HIT and its Impact on Workforce Development

A Web site titled NetAssets has published the first of a five part series on HIT and its impact on workforce development titled: Part I, HIT Overview

This evening I am in a writing mood and just couldn’t resist commenting on their post. One of the things a blog does is allow me to post my thoughts where friends and colleagues will see them rather than scattering them on fence posts, at the base of trees, and fireplugs around the neighborhood. Comments that would have been scattered at the end of other peoples’ posts just a year ago now go here on my blog.

The three authors of part one, Katz, Saran, and Wool have done a nice job of capturing the current uncertainty surrounding EMRs and the much broader topic of healthcare information technology. Today’s market is badly fractured and still poorly defined. Having said that, I thought it would be fun to take a stand today and look back next week or two years from now and just see how much progress we have made and the direction we have taken.

For what it is worth, my best estimate is that connectivity will be via the Internet with significantly more security at all levels. The primary new employment market will probably be security because is it so critical and the threats will shift as the defenses improve. Block the bad guys here and they will move over there and we have to develop new blocking mechanisms. Then they move again. Security is always more of a process than a project.

Data will be stored using existing technology, both software such as SQL and evolving storage media including virtualized systems and clouds. More people will be needed but the skills will be extension of current skills. At lot of today’s designers, programmers, data base administrators, etc., will use the skills they have to move up. There will probably be a big market back-filling jobs in other industries were incumbents have left to go into healthcare. These will be real jobs, just not in healthcare and they may not qualify for government assistance.

Data acquisition – how the data is captured – will be the place where we see the greatest change. The work-load impact of capturing the information is one of the biggest complaints about most EMRs. There will be new technologies and significant improvement in existing data acquisition technologies. And perhaps equally important, larger markets for these new and improved technologies will bring down costs. Almost all of this will happen in industries outside of healthcare. Healthcare will be buyers, not participants.

There appear to be huge training needs to help almost everyone involved in healthcare learn to use the new tools. Fortunately there a lot of people who are already familiar with computers, office applications, and the Internet. We are not starting from square one. Flip side, most of them know very little about security, the place where I began these comments.

Bill Crounse, MD,  Microsoft’s worldwide health senior director addressed this broader training need in a blog post dated October 7, 2009. “Dr. David Blumenthal (National Coordinator for Health Information Technology) has announced a ‘workforce training initiative’ to educate more health information management professionals with expertise in electronic health records and related technologies.  He says at least 50,000 new jobs are needed in the field.  I would add, based on what I’ve experienced, that we will also need training for perhaps ten or twenty times that number of people; i.e. most of the physicians, nurses and other clinicians who are currently practicing in offices, clinics and hospitals all over America.

“It’s not that these folks have their heads in the sand. Most of them are working so hard day to day in patient care, trying to stay afloat and keep their practices from going under, that they literally don’t have time to come up for air.  So what happens when we expect them to use all of this technology and also give 45 million more people access to their services?  That is going to call for one hell of a training program!