BERKELEY, CA (UroToday.com) - Utilization of electronic medical records is both necessary and daunting for most personnel in the medical field.
As in the field of pediatric urology, we all know and have experienced the benefits of technology in our professional and personal lives. Whether it involves preparing a paper with Microsoft Word, emailing coworkers about the plan of care for a patient, reviewing a CT scan at home while on call, or face-timing with friends and family thousands of miles away on an iPad, we have all seen what great advances technology has made on our lives. When we experience these brilliant uses of technology, we often say to ourselves, "surely, electronic medical records can be helpful for our practice of medicine." However, as we noted by the impressions of many of those responding to our survey, the reality is that this is mostly untrue, at least at the present time. Although 97.6% of pediatric urologists surveyed regularly utilize a computer for personal or professional use, only a small percentage of pediatric urologists who have used EMR for the longest period of time (>3 years or more) have reported improvement in efficiency in the outpatient setting. If an EMR is adequately designed and implemented, one would assume that it should actually decrease the amount of work required by the healthcare professional using it.
So, the question for EMR usage at this date and time is this: is the computer working for us, or are we working for the computer? The reality at this point is that we healthcare professionals are the ones often doing the work for the computer to realize only marginal benefits from EMR. Why then is EMR not more beneficial in the practice of medicine? For starters, I believe our vision for successful EMR implementation and usage has not been adequately envisioned. This vision is key since if we do not know where we should be going, we most likely will never arrive at our destination. Once we have a vision for what the ideal EMR should be, then we can better understand how to correct the multitude of problems with EMR usage at the present time. So, what should happen when we are evaluating a patient with the ideal EMR? I believe it should look something like this. The physician enters the patient room, greets the patient, and begins the evaluation. As the physician enters the room, the patient's record displays on a very large 60+ inch LED with all of the patient's recent records, X-rays, and laboratory records displayed as well. The screen needs to be large enough so the physician can access multiple windows simultaneously with ample processing speed to prevent any lag with information entry or toggling from one part of the record to another. Another window is open for the physician to record the details of the current evaluation where the physician uses a combination of voice recognition software, touch-screen entry, and predesigned templates to enter information into the system real-time with the patient actively observing and participating in the process. The physician has the ability to photograph elements of the physical exam to track in the future and to draw pictures on the screen to describe surgeries or some other element of the patient's treatment. Upon completion of the history and physical examination, the physician reviews the recent radiologic imaging and laboratory evaluations with the patient, then the physician arrives at an assessment and plan, records this information on the current note, and concludes the evaluation. Upon the physician leaving the room, the patient record closes, the EMR notifies the nursing staff that the evaluation is completed who delivers the automatically-generated patient education information to the patient and provides the follow-up date and time as well. Meanwhile, the EMR has already billed for the interaction and has generated and forwarded a communication to the referring physician instantaneously before the physician has begun his next patient evaluation.
Where do we go from here? We live in an era where the da Vinci robot helps perform surgeries, where Honda's Asimo robot can run nearly 6 miles per hour,1 where astronomers can observe hydrocarbons on Pluto,2 where the US government can scan approximately 250 million electronic communications per day with PRODIGAL,3 and where a Patriot Missile can shoot down another missile in midair. Yes, the technology is there to realize this vision for delivering healthcare with an electronic medical record. Both the business world and government have surely encountered major challenges where technology has been applied to input data, record data, and communicate data with other business or governmental entities. What can we learn from the creation and implementation of the Electronic Data Interchange (EDI) where the business world developed a system for the transfer of electronic documents or business data from one computer system to another computer system with different companies? How can we apply principles learned from businesses’ experience with EDI and apply it to medicine? Can hospitals or practices with different EMRs communicate secure information in a standard format when necessary such as businesses have done with EDI? Answers to these questions in other arenas will certainly be beneficial in our pursuit of the ideal EMR.
Lastly, upon identifying where we are going and what we can learn from other fields, we then need to assemble individuals with the necessary skills to work toward this ideal. I believe this group should include healthcare professionals - including physicians, information technology experts, industrial engineers, and business leaders who can dedicate themselves toward this effort. With the HITECH Act deadlines approaching and healthcare costs rising, the time to creatively solve the EMR problem is now. I believe that by arriving at our destination of the ideal EMR, we can achieve improved efficiency and improved patient care and, in doing so, make the computer work for us instead of the contrary.
References:
- Obringer, Lee Ann and Strickland, Jonathan. "Honda ASIMO Robot". How Stuff Works. http://electronics.howstuffworks.com/asimo1.htm. Retrieved 15 July 2011.
- S. A. Stern et al. First Ultraviolet Reflectance Spectra of Pluto and Charon by the Hubble Space Telescope Cosmic Origins Spectrograph: Detection of Absorption Features and Evidence for Temporal Change. The Astronomical Journal 143 22. 2012.
- Brandon, John (2011-12-03). "Could the U.S. Government Start Reading Your Emails?". Fox News. http://electronics.howstuffworks.com/asimo1.htm. Retrieved 2011-12-06.
Written by:
Stephen James Canon, MD1 as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
1Associate Professor, Department of Urology
University of Arkansas for Medical Sciences
Chief, Division of Pediatric Urology
ACH Auxiliary-John F. Redman, M.D. Endowed Chair in Pediatric Urology
Arkansas Children's Hospital
Results: Survey of pediatric urology electronic medical records-use and perspectives - Abstract
UroToday.com Pediatric Urology Section