April 16, 2010

Next Phase for the EMR in the Ambulatory Sector?

Filed under: EMRs,Meaningful Use,Specialty Clinical Systems,Uncategorized — HankMayers @ 12:56 pm

Historically, the value premise of the EMR is that:
1. It can simplify the exploding amount of paperwork associated with the medical claims processes, government monitoring of the public health, and access to and support of medical research,
2. It can reduce the significant costs in storing and moving paper charts,
3. It can greatly simplify the effort in sharing paper records amongst external practitioners,
4. It can largely eliminate the legendary complications associated with physician handwriting

None of those factors are going to change to any great extent; they are part of the very nature of health care in the 21nd century. Put another way, anyone hoping that EMRs are a fad is destined to be disappointed. The momentum for EMRs was building long before the feds put $34 billion on the table.

In the Healthcare Information Technology (HIT) market, EMRs have come to mean:
• A generic framework for a digital record of the care provided to a patient by a practitioner
• An electronic care record that is based on sufficient data standards that information within it can be exchanged electronically with other practitioners caring for the patient
• Provision of evidence-based care guidelines, care logic rules, or other capabilities to advise the practitioner on relevant treatment options, or alerts when a course of planned treatment may initially appear to conflict with care guidelines
• A convenient mechanism to report relevant quality measures to payers and the consuming public
The newest, generally acknowledged, expectations of an EMR is that
• Its data is sharable with a Patient Health Record system that is used by, and is focused on, the patient
• It provides an array of information to the patient to enable a greater engagement of the patient in managing their care and level of health

In vendor marketing of EMRs to serve a broad array of physicians, various specialists have found that EMRs do not address quite a few dimensions of their practice of medicine, and the management of essential patient and clinical information relevant to their slice of medical care. Indeed, a significant number of specialties have been using a specialty clinical system, specifically designed to support the care that they deliver. So it is not surprising when my conversations with some of them result in their sharing their conclusion that EMRs are really built for generalists.

It is my conclusion that they are more than half right.

However, specialists are unwittingly overlooking some of the things that EMRs, as a class of HIT, do so well. I would argue that an EMR, for a specialist, should be their link to the rest of the medical community. After all, it provides that ability to construct the base medical record. It also does that in a way that makes it sharable with the rest of the patient’s care team. It also puts them in a position to be informed of care events from beyond their walls. EMRs can also greatly ease the advanced clinical documentation/coding being increasingly requested by payers, including quality reporting. Finally, many EMRs provide patient-portals to help manage communications and basic transactions with patients.

While most specialists won’t dispute these features as valuable, they all are logically saying that the real value for an EMR for them is to seamlessly integrate with their specialty clinical system. In that regard, they have the same reasonable desire as their cousins in the inpatient setting.

This is a reasonable, but not necessarily easy to achieve, expectation.

The EMR vendor community has not been blind to this challenge. Many of the EMR vendors provide versions or features built to address the unique treatment models used by various specialties. One of the earliest additions was the ability to process and record DICON-based images as part of the chart. But it is clear, for many specialists, these are half measures.

I find myself quite interested in knowing more about how the vendor market is moving to address the evident need for the EMR products to integrate with the specialty clinical systems. Seems to me that there are 3 potential directions:
1. EMR vendors building strategic relationships to fully integrate with one or more market-leading specialty clinical systems, or
2. EMR vendors choosing to offer fully integrated specialty clinical systems for certain specialties, or
3. Specialty clinical system vendors building EMR “front ends” for their existing products

What are folks seeing in the vendor market on this front?

Comments, anyone?



  1. Good point. It’s an issue no one is really talking about yet. I agree that integration with practitioner clinical systems is essential.

    Comment by A.B. Barber — April 29, 2010 @ 7:44 am

  2. We learn that, for example that the American Board of Internal Medicine now riqeures in their competency maintenance scheme that physicians show competence in patient registries development and survey feedback.They conclude stating “physicians should be well positioned (once they get the right tools) to provide the services and care that patients want and have the right to expect”This is beyond absurd.It just so happens that biomedical registry development (which riqeures strong competencies in biomedical data modeling, controlled terminologies and other areas, with all the nuances and idiosyncrasies these activities entail) will not be a competency most physicians will want to, or need to, have.See, for example, on how biomedical data modeling was severely farkled by the “experts.” too.

    Comment by Rosa — November 20, 2014 @ 12:35 am

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