Solution?: Modular EMR Suites

One of the biggest happenings in the software IT field  recently has been the publishing of the EMR ‘meaningful use’ guidelines (I say ‘happenings’ because I believe ‘developments’ is too positive a term). Like any other government recommendation, the rules are vague over-generalizations made by ill-informed lawmakers. Surprise. However, there are a few indirect, potentially informative,  implications of these guidelines.

The idea  is that if you follow these guidelines, you will get a modest stimulus. The important part they don’t mention in this stimulus schedule is that there will actually be penalties for non-compliance by 2015. Enough ranting.

Some companies are aiming to make the ‘EMR to end all EMRS’. My client got sucked into this sales line and has since regretted it. Perhaps we health IT folks (or at least I) should listen to our own advice. Many of the gripes about  ‘meaningful use’ are with it’s over-generalization. So why should we not also gripe about over-generalized EMRS? It seems like if we want to maintain our  (my) opinion about these new guidelines, we should put our money where our mouth is and spend the time/money to get the right tools.

Disregarding any specific numbers, one thing the guidelines do get right is that they have managed to somewhat compartmentalize different aspects of possible health IT applications. Perhaps we small EMR vendors can take a hint from this and develop tools for each of these aspects. This way, when the Goliath EMR products fail to deliver, we smaller Davids can gather our forces to provide actual care and productivity improvement for our clients.

A few examples of this model in use are the different office suites offered by vendors like Microsoft, Apple, Adobe, even Sun (OpenOffice). Sure, the subprograms like Excel and Word work well together (you can cut and paste, etc.) but you don’t write your history essay in excel or do your spreadsheets in word. Why would we want to write prescriptions on the same platform we review radiology imaging?   We need to re-think the necessity of total tool integration and consider other separate, loosely-coupled  solutions.

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4 Responses to “Solution?: Modular EMR Suites”

  1. Rick Orlowski Says:

    This project will define meaningful use in the medical oncology outpatient setting because it is based on real world problems and events. We will solve clinical problems on a rational basis and make patient care better.

    The idea of a government entity defining “meaningful” is humorous; perhaps we could apply the term to government programs and see what we get. Perhaps they want to work on the term “efficiency” next..that would be something. The reason that the idea of meaningful has to be applied is a result of current government regulations in the first place. These regulations require that so much unmeaningful verbage be included in notes that it is difficult sometimes to even know why a doctor visit occurred. Government documentation mandates are not founded in good clinical practice and get in the way of thoughtful efficient intervention. Current EMR’s spit out excess, irrelevant verbage right and left to satisify inane check lists of government auditors. It is preposterous. Because what they now demand is not meaningful the regulators must turn around and demand that something meaningful be done.

    We are doing this project to satisify the needs of our patients. That will be more than enough to satisify a mindless bureaucratic guideline.

  2. orlowski Says:

    Dr. O,
    I actually was going to bring up another viewpoint for another post but it is relevant here. Why are there not ‘meaningful use’ guidelines/requirements for software for insurance companies, or auto makers or financial companies. The government seems perfectly happy to let an insurance company do their life-affecting dealings in paper.

    In those industries, the driving force is competition and you will be crushed with a paper system. No one wants an insurance company that can’t give them an invoice immediately or that takes 2 days to give a quote. In medicine, the driving force SHOULD BE better care, which is not necessarily dependent on the format of record keeping.

    Medicine is driven by humans, not software.

    It seems to me that these guidelines are another knee-jerk reaction with limited benefits to fulfill some ill-informed notion that good healthcare can be driven by actuarial tables.

  3. Rick Orlowski Says:

    What will be meaningful for us is:
    1) patient tracking and movement, reducing wait times
    2) presentation of data for decision making…historical doses, lab results
    3) standardized drug use via protocals as a safety measure
    3) dose checking for safety
    4) scheduling efficiency for future treatments
    5) documentation as a means to focus MD/nurse effort and for medical-legal purposes

    as starters.

    Later versions can mine data across our patient population concerning outcomes and complications and assist with clinical trials and patient management.

  4. Connectivity, not completeness will create a winning EMR product « Ankhos — Oncology EMR Says:

    […] Ankhos — Oncology EMR Chronicling the origin and development of an Oncology EMR for a private Oncology/Hematology practice « Solution?: Modular EMR Suites […]

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