Saturday, July 25, 2009

Some Notes and Then Myth #4, EMRs...

In this slow summer, we are working through the Seven Myths of Healthcare Technology. Myth #2 is "Technology Can Do Healthcare." [check it out below] Here's a comment I found out there--The writer certainly seems to have a reason for his anger. But is he completely correct? What do you think?
Community College - No Way

And is this an attempt at something "Swiftian?"
"Eat the Elderly" kind of stuff? Or do you think he is serious? With all of the alternate-reality based rhetoric being put out there, I am honestly unsure...

And it looks like telehealth is happening without complex, expensive proprietary software systems...
The doctor is in and logged on

And we continue with…

The Seven Myths of Healthcare Technology; #4 EMRs are for the Doctors

As hospitals and medical facilities move to meet the technological mandates and requirements coming their way (from managers, regulatory agencies and insurance companies), they are confronting the issue of stakeholders--who are they and who is most important. Historically, the final word in healthcare has been that of The Doctor. What the MD says goes. As software is implemented in more and more systems, vendors and internal IT staff are having to customize and personalize software for each facility and clinic.
Healthcare software is not “off the shelf,” as some vendors might present it. It is more “out of the crates, custom-tailored, re-measured and stuck with unusual plug-ins and attachments to serve the vicissitudes of legacy systems.” In the process of making these applications work in the particular digital and business environment, sensitivity to end-user experience is considered essential. And doctors are the obvious end-user stakeholders.
Doctors are characterized as (just a little) demanding. Nurses everywhere tell tales (or at least roll eyes). This is no different, and perhaps worse, with software. Doctors are a technically saavy group and not shy about speaking up. But they are the wrong users on which to model EMR use.
Doctors use EMRs to mostly see data. They look at one or two views of data; to review intake information, view images; check results, or, watch for drug allergy alerts--then they look at the patient. They use systems to place orders or prescriptions--sometimes. Often, these orders are completed by PAs or nurses. Doctors do not move through an EMR very much--they tend not to do patient intake or to record new data very much. They are not the primary users of the digital tools---their skills lie elsewhere. There are certainly providers who are more “hands-on” with electronic systems. These are usually providers in record-intensive practices such as psychiatry or in the unique practice structures of the military.
Clerks, Nurses and PAs are the big users. They are the people using the record systems most--from patient intake through scheduling to checking for labs and rads. Very often it is they who bring up the patient record for a doctor and file orders. And it is the desk staff who are using the EMRs to communicate with insurance companies and other referral facilities. It is their workflow that should be modeled--and theirs are very different workflows.
People will say “Nurses really run the hospital.” I won’t get into that debate, but I will say “If they don’t control the hospital, they certainly control the information in it,” and that is the EMR…..

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