A recent conversation with an early EMR adopter healthcare provider resulted in an interesting dialog about the value of an EMR to the clinician, and the question of whether EMRs are really physician friendly.
Many EMRs seem to structure data around particular specialties. For example, a chest X-ray and report would be associated with a radiology tab, while an echocardiography exam and report would be associated with a cardiology tab. A patient seen in a clinic such as dermatology might well have a separate tab for dermatology.
Obviously this makes sense for the organization of data, and for the convenience of the service generating the information. What it does not make sense for is the physician that is looking to follow a patient’s medical history, particularly for a related medical event.
Take for example the situation of a patient that may have suffered some form of injury that involves both internal as well as an external wound injury. In the course of diagnosis and treatment, the patient may have received some diagnostic imaging exams such as a CT or MRI, along with a surgeon’s involvement to close a wound, and potentially a wound physician to treat the site post-wound. In this case the wound care physician may be interested in reviewing the historical aspect of the wound in planning a course of treatment.
To access the historical aspect of the injury, the wound physician might have to look through multiple tabs in the EMR to retrieve the historical bits of the injury, diagnosis, and treatment – a tedious and potentially error-prone process. Wouldn’t it be desirable for the physician to have some mechanism for having convenient access to all the relevant information pertaining to the particular injury, regardless of the service where the information was acquired?
From a graphical user interface (GUI) perspective, it would be advantageous to the physician if all the relevant information relating to the injury/disease process were presented chronologically to the physician. Selecting a particular event could then launch the physician to that particular EMR detail – as long as there is a convenient means of getting back to the overview.
The question then becomes … in whose interest is it to present the information in this form? The EMR vendor? The information storage vendor (if separate from the EMR vendor)? Or someone else? All of the procedure documentation is most likely in the EMR (along with pointers to content), but the actual image or document content might reside in another system. For example, there may be images, videos of the surgery, and documents representing the reports, which may be stored in multiple systems.
My current healthcare provider has an EMR, as well as physician and patient portals. As a patient, I can access some exam results on the patient portal site, but not all of them. Lab results are presented chronologically but I can’t see certain diagnostic exam results such as a cardiology exam report. I suspect (from the interactions I have had with my clinician) that the physician cannot see anything other than specific exam results either. So, neither of us is capable of any meaningful tracking capability using the portal.
Will EMR vendors see this as an opportunity to develop alternative user interfaces to enable a physician chronological view? Or, is there an opportunity for third-party developers to interact with the EMR to extract the information for a chronological view and workflow process? This would seem like an EMR function, and a missed opportunity for EMR vendors. But, then again, EMRs serve many different purposes, and perhaps it would be more appropriate for another clinical application to address it.
I welcome your perspective. Is this an issue in your institution? Are there applications that can already do this? How valuable would this be to the clinician? I look forward to your responses.
