Top 5 things my patients and I need in an EHR

There is a lot of exciting innovation in the Electronic Medical Record space right now, in part thanks to meaningful use dollars available from the American Reinvestment and Recovery Act.

That is good new for patients and doctors both.  I’ve got my eye on a few of innovators in the space, both young startups and more mature companies.  I’ll write about some of them soon.  But first I wanted to list some of the key features that an innovative (or disruptive!) EHR should include.  I’m not talking about HL7 feeds and HIPAA compliance here.  Those kinds of things are important, but I’m interested in innovations that have the potential to be transformative—or at least empowering.

#5 – Integration – Especially with medical imaging

OK, I know I just said I wasn’t talking about HL7 feeds.  But there is more to EHR integration.  When I publish this post, it will automatically get posted to Twitter and Facebook…without HL7, thanks to APIs.  Any EHR worth its salt should expose an API so that others can integrate with it, extend it, and innovate on top of it.

This is especially important when it comes to viewing medical images, like CT scans and MRIs.  Ideally, the EHR itself should be what I call the “clinical viewer.”  (A clinical viewer is like a PACS that emphasizes clinical necessity and convenience over advanced visualization tools.)  But, most EHRs aren’t there yet, and clinical viewers are in their infancy, a topic I’m speaking on at the Society for Imaging Informatics in Medicine this June.  So, if the EHR can’t have a clinical viewer built right into it, it should at least expose an API robust enough for a clinical viewer, or any other clinical application, to integrate with it.

Why?  Because medical images are freaking important, that’s why.  And so are about a million other different things and use cases, including a boat load that haven’t even been thought of yet.  Closed platforms are sooo 2001.

#4 – Interoperability: Read: “web-based”

It doesn’t matter what computer I’m at, what network I’m on, or whether I’m on a Mac or a PC.  I want access to my EHR, and I want it to be the most up-to-the-minute version of that EHR.  This means the same thing it does with any other software platform: it should be web-based.  Clients are inconvenient and unnecessary.

When I was a medical student waaaaay back in 2005, I was using CareWeb at the University of Michigan.  It was a proprietary system, and it was one of the first web-based EHRs.  It was young technology, but at the time it was truly visionary.  I’ve missed it ever since, and I can’t wait to get back on to a web-based EHR.

#3 Mobility

Medicine is mobile.  It always has been.  EHRs need to be too.  It’s that simple.

When I graduated from college in 2003, I asked my parents for a tablet computer to use in med school: the Motion Computing M1400. I wanted to use it to take care of patients.  It ran Windows XP Tablet Edition.  Remember Windows XP Tablet Edition?  Probably not.  It was Bill Gate’s failed attempt to make the tablet computer mainstream.  Luckily, Steve Jobs has succeeded, and the usable, useful tablet is here.  And everywhere.

Having a web-based EHR per item #4 partially addresses this, but doesn’t go far enough.  I’m talking true mobility: zero footprint, HTML, runs in any mobile browser, with an optimized mobile interface.  BUT, I’m still not talking about clients (see Interoperability!).  I don’t want an app for that: I want a mobile web app, thank you very much.

#2 Outside Provider Access to Records

Guess who needs access to my patient’s records besides me?  Every other doctor they go see.  Ever.

Right now, unless everyone is a member of the same large health system, the patient’s records are stored in unshareable silos.  The orthopedic surgeon’s notes are in his EHR.  The cardiologist’s evaluation is in her EHR.  But, the orthopedic surgeon wants to know what the patients cardiac risk factors are BEFORE he takes the patient to the operating room.  So what happens?  The cardiologist’s office employs someone who FAXES the cardiology records to the orthopedic surgeon’s office.  Let me say that again: FAXES.  Or, if it’s not urgent, they might MAIL them.  No “e”, just mail.   Ridiculous.  Inefficient.  Wasteful.  And potentially dangerous.

There MUST be a mechanism to share my patient’s records with other doctors.  Control over sharing should be in the hands of the patient, both for common sense privacy and for HIPAA compliance.

#1 Patient Access to Records

This is, by far, the most important feature of any worthwhile EHR.  If it doesn’t offer this, it’s a nonstarter in my book.  I believe access to one’s own medical information is a basic right, and thanks to HIPAA, so does your government.  YOU own your medical records, just like YOU own your health.

When we put information into the hands of patients, we empower them.  We create a mechanism to reduce errors.  We increase communication and understanding.

The age of paternalistic medicine is over.  The age of participatory medicine is here.  The new EHR must facilitate participation.  Oh, and by the way, patient access to scheduling and billing is pretty cool too.


One thought on “Top 5 things my patients and I need in an EHR

  1. Pingback: EHR Innovators Part 2: drchrono | disruptmedicine

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