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  The Health Record Review
by Jeff Marion


The EHR 'killer app'

Posted on Tue, Jul 28, 2009 - 09:54 am

While providers scramble to roll out EHR systems in time for ARRA funding, physicians have declared war on the clunky, proprietary software they are required to use. It complicates work flows, requires unnecessary data entry, and wastes time with superfluous windows and buttons, requiring the use of a maddening series of drop-down menus, mouse clicks, and work-arounds to perform even the simplest tasks. Today's EHR systems are sorely in need of the 'killer app', a term familiar to all professional computer programmers and software designers.

Short for "killer application", the term was coined as nerd-jargon to describe software so well-designed, so necessary and important, that it sets the universal standard for its niche. Examples would be Microsoft Office, Adobe Acrobat, Apple's iTunes, and Google Maps. In the online sphere, the title could be claimed by the likes of Amazon, Facebook, and Twitter.

So where is the EHR 'killer app'? Unfortunately, it doesn't yet exist, and instead providers find themselves courted by innumerous EHR vendors, each offering their own, proprietary methods for accomplishing familiar tasks. If providers aren't careful, they might find themselves locked into vendor-specific software systems and siloed IT universes.

Some providers are growing wiser, demanding more flexibility in selecting hospital software systems. CCHIT has recently expanded its certification criteria to include module-based alternatives, whereby a physician could integrate different modules from different vendors, each certified for a different function (e-prescribing, lab results, charting, data exchange). This model has proved fruitful for iPhone users, with the best apps quickly rising to the top of the "most downloaded" list.

So why are hospitals implementing clunky, unproved systems that cost millions of dollars, drastically alter familiar processes, and contribute to the unsettling trend of deinstallation? Perhaps those designing the software are not necessarily the ones most familiar with the day-to-day needs of physicians. Providers are also rushing to implement something, anything, in time to qualify for ARRA funds and avoid harsh penalties.

As EHR software becomes more wide spread, hopefully an evolutionary "survival of the fittest" will kill off the real clunkers, and the best EHR systems will rise to the top of the "most installed" list.

Over and over again we hear that for an EHR to be successful it must have full buy-in from hospital staff. Providers should be careful, and do their research on what others are using, all the while holding their breath until blue in the face, awaiting the EHR 'killer app'.


Comments

Posted by EMR Matt on Tue, Aug 11, 2009 - 08:41 am.

EHR and Private Practice are at odds. Since 2000, the cost of running a medical practice has increased 40% while reimbursements have declined between 17 and 35% depending on geography and specialty. As a result, physicians are seeing twice as many patients to make the same amount of money. What they lost in margin, they've made up in volume.

But today, there's not time on the schedule for another patient visit. The killer app, will address the harder hitting efficiency needs of a practice before attempting to model/change a physician's behaviour.

A practice considering traditional EMR is facing economic suicide. Let innovation rule. www.simplifyMD.com

Posted by anthonyn000 on Mon, Aug 03, 2009 - 12:56 pm.

I agree with comments that current EHR systems are inefficient. Additionally, most practice management systems seem to allow physicians to enforce bad practices rather than improve on current workflows within the practice. The EHR systems should improve the physicians day to day operations and allow them to provide a better quality of service to the patients.

Unlike most software development industries, health care IT is distinctly lacking in innovation at this time.

My concern for the security of electronic records within current systems is extremely disconcerting. Any addition of technology should come with easy to use, self-auditing and secure software packages to help patients fears of data breaches.

Anthony Niehaus
http://ehrtech.info

Posted by rweston on Wed, Jul 29, 2009 - 06:42 am.

The reason the "Killer App" you seek doesn't yet exist is that the vendors have committed the the most basic mistake when designing a computer application. They've replicated a paper process.

They need to throw away the concept of the Office Note/Op Note in a prose format, and treat the data as data. Along with that Providers need to come to grips with the reality that they are not writing a novel, but collecting data.

Providers are never going to willingly adopt a system which makes each visit longer, or which places additional burden on them to take on things they view as back office functions (e.g. coding).

I work in orthopaedics and one of the most difficult things to template is the location of the complaint(s), and then attach symptoms, etc. to that location. Add multiple complaints (locations), with different symptoms at each location and your template's complexity, and the numbers of levels in your glossaries become so deep, they become unusable.

The EHR vendors should take a lead from mapping software and look at using interactive drill-down diagrams as a means of replacing all the prose. The old adage, "A picture is worth a thousand words" applies.

There are ways to solve these problems but I just don't see the EHR vendors being innovative, or thinking "outside the box."