Key features of a dream EMRs/EHRs
I’ve been in my residency program for almost 5 months now, and over that time, have had a chance to work with a few different Electronic Medical Records (EMRs) a.k.a. Electronic Health Records (EHRs).
There are two different beasts: a hospital records system and a clinic records system.
I’ve also used a few in-office EMRs. One is a non-Physician IT Office (PITO)-approved one, and the other, one of the main PITO programs in use in my city called MedAccess. Each has its faults and strengths, but it comes down to two big things:
- if it crashes regularly or is boggy and slow, we will ALL hate it
- if it isn’t easy or intuitive to do basic tasks (like renew prescriptions or do billing), we won’t want to use it
Generally, I support the idea of a universal record, like a provincial medical record that would work both in-hospital and in clinic. The clinical version would have to be somewhat pared-down, and yet include extra features (like workers compensation documentation, well-baby records, and a different billing structure).
In hospital, things are generally more comprehensive than in clinic. Unfortunately, in all places I’ve worked, we are still dependent on a paper chart for progress notes and (often) for order recording. I have used hospital record systems in 3 other Health Authorities, and each was a different program with advantages and disadvantages.
I should probably also declare that my undergraduate courses were in Cognitive Systems, which has a lot to do with human-computer interfaces. As such, I come at this with a slightly deeper than average understanding of what computers CAN do and how they SHOULD work with humans. On the other hand, I’ve never personally (financially or emotionally) invested in an EMR, so I don’t really know what it’s like to be in EMR Purgatory.
If I had a dream Hospital Record System, it would have these features:
- able to view all past progress notes/consultations with ease
- display of inpatient and outpatient lab data
- display of inpatient and outpatient/private service imaging reports, and the ability to view the original images by a click (i.e. link to PACS)
- automatic inclusion of Pharmanet (prescription tracking system)
- able to type in or dictate progress notes directly into the system; inclusion of templates like the Admission History and SOAP note structure
- some capacity to include a line-drawn image of the body (front/back), head (front/back), hand (front/back, L/R) in order to indicate injury or exanthem patterns
- direct order entry with provisions for medical learners and verbal orders via nurses
- a place for nurses to enter vital signs and have them graphically plotted
- linked to the patient’s family practice clinic record
- consistent software or inter-connectivity throughout region/province/etc.
- companion software for PDA/iPhone; i.e. doctors can view Rounds List (and basic patient data) on a mobile device and record ‘stumps’ for progress notes
- capacity to print outpatient prescriptions and to formulate a discharge summary that automatically includes in hospital meds, lab results, etc.
- ability to print out a summary for patients to keep in their own records
- remote access-capable
- secure – login/password or access key/password
- no allowance of user to lock computer (i.e. be-logged in or logged-off, not ‘reserve’ a terminal)
- includes the use of terminals that can access stored data during maintenance down-times
- doesn’t crash!
What am I missing?
One day, the computer will be a helpful tool rather than a barrier to interaction and productivity. We are getting close!