With Obama becoming the new president one of his goal is to have EMR for every individual by the year 2014. First of all, let’s clarify what is EMR (electronic medical records). An electronic medical records system typically is referring to the software a clinic or hospital uses to store patient data and to create a patient work flow.
In some ways, president Obama is looking for PHR (personal health records). In the grand vision, a patient can go to a clinic and provides his/her credentials, and have the EMR at the clinic or hospital integrate his/her personal information at admission. The diagnosis and treatment will then be build base on a patient’s previous medical records. Where is the patient data stored you ask? The is among the biggest challenge. Security is the foremost issue that comes to mind. It is a good question and it will need to be addressed by both government policy and technology.
In order to provide better health care through technology, I believe three different phases will have to occur.
1. EMR system needs to become widely accepted and used by clinics and hospitals across the country. (Hopefully a handful of better implementation will survive and they will become the de facto standard when a clinic decides an implementation)
2. A regulation/standard is implemented by the different EMR vendors such that different system can exchange data with another system with minimum effort. This will begin a movement where the user can take their medical history to another clinic or hospital. In this phase, people can start the implementation of PHR.
3. Analytic reports can be build on top the data that has been collected in the system to provide better patient care. The goal is identify trends that can be beneficial to medical research. In this scenario, the patient’s data will be confidential and the whole data is viewed as a cohort.
Is this possible by 2014? I think it is fairly aggressive. Yet, one will always have to take baby steps first. At this point let’s dig deeper into the first step which is how does one evaluate an EMR system. Here are some key points I believe must be taking into consideration during an EMR evaluation process.
- Security and audit trail is of the highest priority. The potential issue with audit trail is the amount of data generated. Some sort of backup/purging algorithm will need to be implemented.
- A patient’s record must be accessible to the health care professional base on the privilege assigned (E.g. doctor and nurse will have different access privileges base on their responsibility for the patient)
- The software itself must be very customizable. Customization is crucial when it comes to vocabulary terms. Every hospital will have different vocabulary that is specific to that hospital.
- It must be affordable. The cost of an EMR is not simply software. One will also have to consider the hardware requirements, amount of training, and IT support personnel requirements.
- It must be intuitive to use. In order to enable the doctors to focus on patient treatment, they should not need to allocate a tremendous amount of time to learning software.
- It must enable simple data extraction. If a user wants to take his data to another clinic, there should be a way for the user to accomplish this. Even though HL7 standards were created for this purpose, it is not supported by a lot of systems.
- It should provide seamless upgrade process. The is a general statement regarding software but especially true within the health care industry. Doctors should not have to go through a large learning curve simply because the software was upgraded over the weekend.
- It must respond in a reasonable and timely fashion even two people are access the same record. As with any software, performance is always highly valued.
- It must have clear error messages. The worse thing that can happen from software perspective is to give generic error messages.
- It must have alerts and reminders. E.g. the system might check to see whether the drug dosage perscribed is abnormal in comparison to the height and weight of the patient.