Oncology EMR – Lofty Goals

Speaking in a pseudo-panic, I called the lead physician at Carolina Oncology Specialists and asked this question.

“Why do you need this EMR software?”

I had been commissioned to write an electronic medical records program for this medium-sized oncology office in Western North Carolina, but had suddenly become unconvinced that what I was writing was 1. necessary and 2, relevant. COS has had a long history of success and prestige in its market and although its customer base was rapidly expanding, its paper charting system was working well. Why fix what ain’t broke?

I didn’t want this project to become a case study in wasted development and poor planning; I needed validation that this software would truly improve the lives of the patients and employees of COS. The lead physician, Dr Orlowski (My Father) eased my panic and we concretized our previously nebulous goals. The on-going pursuit of these goals will be the foundation of further discussion on this blog:

The goals we outlined are:

1. Improve patient safety — dosing precautions, tracking allergies, etc.
2. Increase office productivity — less time looking for charts/patients
3. Reduce patient waiting time
4. Record an up-to-the-minute accounting of office events
5. Create auditable data trails for reporting and potential future government quality assesments
6. Provide backwards-compatability with the current paper chart system.

and…

7. Call it an EMR

We agreed that “having an EMR” was not enough. It had to actually make life better for the people who used it. What good is having an EMR if it grinds your office to a halt?

3 Responses to “Oncology EMR – Lofty Goals”

  1. Marcia Orlowski Says:

    It is easy to say ‘make life better for the users and the patients’. keep paying attention to getting clear on what life looks like when life is better and keep asking the questions as you create and test your software. The software you create cannot change people’s behaviors on its own, though, if well designed, it will go a long way to changing behaviors of the users and result in excellent patient care as well as provide statistics for future treatment.
    Just as you got the commitment of the lead doctor and the head nurse, they will in turn have to get the commitment of the users to use the software with the same commitment of the leaders…..to make the lives better for the users and the ultimate goal, those of the patients.

    When our actions, inventions are connected to what we declare we are taking care of in this world, then that prt of human nature that wants to do something meaningful in the world, that is contribute, then you are much closer to real commitment to excellent care rather than compliance or grudging compliance. Compliant folks are not really enrolled, may not really be on board, may do just what they are told without being awake at the wheel. This is not enough for health care providers that are held accountable.

  2. orlowski Says:

    At what point should I try to change the behavior of the customer? It is undeniable that the implementation of a new software product will cause changes in their workflow, but if we assume that the office is currently working well, should my goal be not to change the way they work but to make their process more efficient?

    I am scared to death of making this office less efficient by using this software.

    Should i leave it to the lead nurse and doctor (or anyone with subject matter expertise) to decide when a behavior change is necessary? From my past employer I learned, many times over, that good software can make the client ask hard questions about their own behavior… and will correct it themselves.

  3. marcia orlowski Says:

    Your fear about ‘less efficiency’ may or may not be grounded. How are you defining and measuring efficiency? Yes, the software tool you are creating may add steps to the workflow/process, but that may be needed to gain the other requirements…increased safety, fewer errors, less waiting time, increased trust with the patients that they are getting excelllent care, data for future assessments, capacity for increased business, etc.

    A good example is today’s concern in hospitals for reducing the incidence of infection in surgery. Doctors and nurses have had to change their behaviors, that is, more steps in order to reduce infection rates. Is this a change in efficiency? Nurses and doctors are required to call out in the operating suite when one of them has not followed protocol, ie proper cleansing of hands, surgical site, etc. Nurses and doctors are to cleanse their hands upon entering and leaving a patient’s room. This is their job. If patients learn that a particular hospital has had high infection rates, the patient chooses to go elsewhere if he is smart.

    Behavior change is ongoing, we have to assume that as designers, especially if the users and leaders are holding a culture that promotes continuously asking the hard questions recurrently. Are we really doing what is essential for quality care?

    The office is working well. This was not so in the past. Yes, the head nurse, office administrator, lead doctor, others must be awake to breakdowns, needed changes in tools, behaviors, quality, requirements from government, and more. At the same time, you may see something that the customer does not see, and you reccommend behavior shifts.

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