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Improving EMRs 2009


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These slides review problems with current electronic medical record (EMR) systems and makes suggestions for future improvements in design and usability. This work was sponsored by the Szollosi Healthcare Innovation Program (

Improving EMRs 2009

  1. 1. Improving EMRs Problems with Current EMRs Thoughts on Future EMRs April, 2009 Lyle Berkowitz, MD, FHIMSS Program Director, Szollosi Healthcare Innovation Program ( ) Email: [email_address] Web:
  2. 3. Usability Problems <ul><li>The NRC Report (Jan, 2009) Summary: </li></ul><ul><li>Built to resemble paper charts </li></ul><ul><li>Overly focused on Compliance, not Care </li></ul><ul><li>Too much clinician data entry and searching </li></ul><ul><li>Problems with Data sharing and integration </li></ul><ul><li>Transaction systems with decision support bolted on - rather than as thinking systems with transactions built in </li></ul>Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions . Authors: Willam W. Stead and Herbert S. Lin, editors; Committee on Engaging the Computer Science Research Community in Health Care Informatics; National Research Council. http:// =12572
  3. 4. Current vs. Future EMRs <ul><li>Future EMR </li></ul><ul><li>Metaphor: iPhone, Web </li></ul><ul><ul><li>Graphical representation </li></ul></ul><ul><ul><li>Information Visualization </li></ul></ul><ul><ul><li>Interactive/Actionable View </li></ul></ul><ul><li>Workflow oriented </li></ul><ul><ul><li>Context is Critical </li></ul></ul><ul><ul><li>One Click </li></ul></ul><ul><ul><li>Documentation as byproduct </li></ul></ul><ul><li>User control </li></ul><ul><ul><li>Data separated from App </li></ul></ul><ul><ul><li>Open API </li></ul></ul><ul><li>Current EMR </li></ul><ul><li>Metaphor: Paper </li></ul><ul><ul><li>Word/Excel </li></ul></ul><ul><ul><li>Information Overload </li></ul></ul><ul><ul><li>Static View </li></ul></ul><ul><li>Task oriented </li></ul><ul><ul><li>Data and Fx Silos </li></ul></ul><ul><ul><li>Too Many Clicks </li></ul></ul><ul><ul><li>Documentation as end product </li></ul></ul><ul><li>Vendor control </li></ul><ul><ul><li>Tightly bound 3-Tier </li></ul></ul><ul><ul><li>Closed system </li></ul></ul>
  4. 5. What will the Future look like?
  5. 6. Short-Term: 0-5 years <ul><li>Compare: Traditional vs. Future </li></ul><ul><li>Breaking up the 3-Tier Monopoly </li></ul><ul><li>Examples </li></ul><ul><ul><li>Information Visualization </li></ul></ul><ul><ul><li>Context Sensitive Screens </li></ul></ul><ul><ul><li>Widgets </li></ul></ul>
  6. 7. The Current 3-Tier Monopoly of EMR Vendors “ Get those vendors to separate their data from their application .” – Dr. William Stead (Jan, 2009) Data Storage Application Processing User Interface
  7. 8. Separating The Data from the Applications The Data “Platform” Physician Workflow Tools Data Storage Application Processing User Interface Application Processing Application Processing Application Processing Application Processing Application Processing Application Processing Application Processing Application Processing User Interface User Interface User Interface User Interface User Interface User Interface User Interface
  8. 9. Another way to look at it Multiple Care Settings Single Care Setting EHR EMR PWT EMR PWT PWT PWT
  9. 10. Potential Future for EMR Vendors <ul><li>Good </li></ul><ul><ul><li>Higher adoption </li></ul></ul><ul><ul><li>More widgets to sell </li></ul></ul><ul><li>Bad </li></ul><ul><ul><li>They become commoditized to Data storage experts </li></ul></ul><ul><ul><li>Users start consolidating </li></ul></ul>
  10. 11. New Ways to Look at Information
  11. 12. Problem List: Current View
  12. 13. Problem List – Future View #1
  13. 14. Problem List – Future View #2
  14. 15. Problem List – Future View #3
  15. 16. A New Way to Look at Results
  16. 17. A New Way to Look at Results
  17. 18. Context-Sensitive Screens and Widgets
  18. 19. Problem Details
  19. 20. Problem Details
  20. 21. Med Refill Widget
  21. 22. <ul><li>Patient </li></ul><ul><li>Name: Joe Kind </li></ul><ul><li>DOB: 01-01-60 </li></ul><ul><li>Medical Record #: 123456789 </li></ul><ul><li>Allergies: </li></ul><ul><ul><li>Penicillin (Rash) </li></ul></ul><ul><li>Active Med List </li></ul><ul><li>Norvasc 10mg </li></ul><ul><li>Lisinopril 20mg </li></ul><ul><li>Zocor 20mg </li></ul><ul><li>  </li></ul><ul><li>Appointment Data </li></ul><ul><li>Date of last visit: 1/17/09 </li></ul><ul><li>Date of next visit: none </li></ul><ul><li>  </li></ul><ul><li>Notes </li></ul><ul><li>Actions </li></ul><ul><li>Contact patient to review </li></ul><ul><li>Repeat K in one week </li></ul><ul><li>Increase cholesterol medication </li></ul><ul><li>RTC in 6 weeks </li></ul>IM Cardiology More <ul><li>CHEM PANEL </li></ul><ul><li>Creatinine: 2.2 </li></ul><ul><li>Potassium 5.4 </li></ul><ul><li>LFTs - WNL </li></ul><ul><li>  </li></ul><ul><li>Cholesterol Profile </li></ul><ul><li>LDL 124 (Goal < 100) </li></ul><ul><li>HDL 44 (Goal > 45) </li></ul><ul><li>TG 122 (Goal < 150) </li></ul><ul><li>  </li></ul><ul><li>CBC </li></ul><ul><li>Hb 14.1 (Normal range: 13-15; Pt Range 13.9-14.8) </li></ul><ul><ul><li>within normal range </li></ul></ul><ul><ul><li>0.3 (2%) below average of last 2 years </li></ul></ul><ul><li>Other: </li></ul><ul><ul><li>WNL </li></ul></ul>Cr K LDL HDL
  22. 23. Future: 5-15 years Transform the Computer From a machine that simply responds to your actions To the best assistant you ever had
  23. 24. “ Patient-centered cognitive support” The authors said the “overarching, grand research challenge” of the computer science research community is developing “ patient-centered cognitive support .” Computer systems need to build virtual models of a patient’s status, models that depict and simulate a theory about interactions going on in the patient similar to those models going on in the head of a physician working unaided by a computer. - NRC Report (Jan, 2009)
  24. 25. A robot that understands…
  25. 26. Current EMR Workflow Patient and EMR wait for Physician Physician does all data review and input
  26. 27. Future EMR Workflow EMR gathers data, creates documentation and suggests a plan Physician reviews and edits EMR summary and plan
  27. 28. Potential Time Savings Physician then has more time to spend with patient for tough diagnostic analyses, education, etc…
  28. 29. This presentation was sponsored by…
  29. 30. SHIP Description <ul><li>Mission </li></ul><ul><ul><li>Use creative thinking and diverse technologies to produce a better healthcare experience for patients, physicians and others associated with their care. </li></ul></ul><ul><li>Vision </li></ul><ul><ul><li>Develop, test, and use innovative solutions within the real world of Northwestern Memorial Physicians Group, and then spread these ideas and solutions outside our organization. </li></ul></ul>
  30. 31. Thoughts on Innovation Innovation is a systemic process that draws insights and ideas from inter-disciplinary groups… in a conscious, purposeful search for innovation opportunities . - Peter Drucker The oldest habit in the world for resisting change is to complain that unless the remedy to the disease should be universally applied, it should not be applied at all. But you must start somewhere. -Winston Churchill Don’t tell me what you can’t do. - Peter Szollosi