Having highlighted the critique of a doctor who thinks EHRs should be taking their lead from cutting-edge Internet technology, it seems appropriate to point to another long-time participant in the EHR world who comes at the issue from a different angle.
Apparently, this commentator has a background in designing EHRs, but in recent years he’s found himself re-thinking his approach.
In part, that’s the result of fielding client complaints. “Typically,” he says, “the biggest complaints are related to altered workflows — usually associated with data entry and EHR-feature navigation. Repeatedly hearing the same complaints made me wonder how EHR systems might be improved, and reawakened my inner EHR designer.”
To our eyes, the most useful part of his commentary comes in the checklist he provides for the “ideal” EHR:
- Building a database that can properly store current and future data elements
- Creating computable representations of clinical concepts
- Developing a sophisticated reporting engine
- Creating a workflow representation that can be adjusted for different users and clinical specialties
- Providing state-of-the-art security and auditing features
- Offering support for data exchange and semantic interoperability
- Providing flexible, configurable user interfaces that support a range of interaction modalities (e.g., voice, touch, mouse, pen)”
With that as the core list of goals, he goes on to note:
“No EHR designer can hope to get all of these features right the first time. This means every EHR is a work-in-progress. Unfortunately…there are no other widely accepted sources of guidance on designing EHRs. Moreover, many problems users complain about have no standard solution. No one knows the optimal way to implement decision support in EHRs or even the best way to implement a problem list. How should user interfaces be adapted to accommodate the wide range of clinical professionals who interact with patients? There are no firm answers to these questions.”
The lack of firm answers, it seems, is at once a challenge and an opportunity. A challenge because road maps just make life easier, but an opportunity because, ideally, the malleability of technology can lead to a broader range of custom-fit solutions.
So we’ve seen the problems he thinks an EHR needs to solve. What specific solutions are you looking for?
Photo by takomabibelot via Creative Commons