Productivity first, electronic records second

A few months back, Carolina Oncology Specialists(COS) purchased an EMR product  and implemented it in the office. This program performed its duties as a comprehensive data repository but ultimately, it lacked flexibility and was not productive for COS. There was also no benefit to the patient experience. In fact, the experience was so counter-productive that the staff at COS demanded to return to paper charts. Kudos to salesmanship.

But the client base (unfortunately) at COS is growing and it is clear that a paper charting system will not scale. If an EMR system was not needed now, it would be soon. This is where I come in.

Before I began the implementation of any type of EMR system, I conducted interviews with the staff and did some research into the oncology EMR products on the market. There are innumerable products, each claiming to be ‘easy to use’ and completely interoperable with other products. Some by large vendors, some by small open-source communities. We signed up for a few interactive demos and had phone conferences with sales people but none could offer the features needed by a medium-sized oncology practice like COS.

The Oncology clinical workflow is different from most medical workflows. Not only do drugs need to be ordered and labs reviewed, but entire treatment schedules need to be managed. Many of the patients are in-patients and need to be monitored not only between office visits, but during one, as well.

Busy Doctors, nurses and administrative staff just don’t have time to fiddle with clunky interfaces ill-designed for minute-by-minute patient tracking. My job has become to help this office not just convert their charting data to an electronic format but also to provide a product that will _improve_ their office efficiency, quality of service and patient throughput .

COS (and Oncology practices, in general) need more than an EMR, they need an patient tracking engine.

2 Responses to “Productivity first, electronic records second”

  1. Kevin Richardson Says:

    You are exactly right! The key is workflow. Creating electronic versions of what users currently have may be the requirement, but that is because people don’t know what they don’t know. Implementing a formal design process in which research is conducted to uncover existing (known) and latent (unknown) requirements and then designing solutions to meet these needs will be the key to creating an EMR that users greet with cheers instead of groans.

  2. orlowski Says:

    Thanks for the comment. One specific example of an unknown requirement we discovered is as follows:

    My client still has an eviscerated installation of their previous EMR. They went back to paper charts, but there were a few things that they decided they couldn’t live without. One of those was patient tracking.

    Even so, the patient tracking mechanism was ill-conceived; there were statuses for patients, but they were mixed with locations. This may seem like an obvious distinction, but there were ‘states’ such as ‘Waiting Lab Results’. Great, we know what this patient is waiting for, but WHERE IS SHE?

    I asked my client “How will you find a patient if their family member has an emergency?” or “Some patients may be confused or lost in a sub-par mental state, how do we keep track of where they are?” These are different questions than “What is this person doing?”

    A lot of the answers to our design decisions come not from some some divine providence but simply asking questions that the client had not considered. I believe this is the case in most successful software products.

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