Monday, November 16, 2009

What EMRs can learn from Twitter

One day I got a message in the EMR from a consultant cardiologist. This was a patient I had sent to the cardiologist after a positive stress test. The message said, click to review the consultant's note in the EMR.

I opened the note and saw an incredibly long note with results of every stress test, lipid, echo and cath done on the patient in the last 10 years pasted into the note. In addition there was even the informed consent statement prior to the cath included in the note. There was a note by the PA and then a note by the consultant buried in this morass of digital ink. It took me 10 minutes to find the consultant's assessment and plan which said to continue medical management. Apparently there was one small vessel that was stenosed and was not worth the risk of intervention.

Got me to start wondering if EHRs have caused us to lose our way; we have forgotten that the primary purpose of the medical record is communication. It seems that E/M coding and medico-legal issues are all that EHRs are being used for.

Can we save the EHR? What if we have a field at the top of each EMR note that allows only 140 characters like a Twitter update and each doctor has to populate this with a summary of assessment and plan before the note can be closed? E.g. "80% 1st diag, stable angina, not worth risk of intervention, recc aggressive medical Mx" This would still leave 53 characters to reach the 140 character limit! Could use this to provide a link to the actual chart note!

We could even make the poor Infectious Disease consultant happy. Every time someone copies and pastes their note into their own, there would be automatic attribution like a RT @IDdoc!

We could have a twitter like list of our patients that we follow and we can see tweets about them by all docs!
So what do you think? Any takers?


  1. Something like this would probably be really effective!

  2. I'm with you 100%. EHRs are about communicating! I posted a while back on why I thought social media and EHRs would be the true killer app in health care, but from a slightly different angle:

    I have an incling there are quite a few big players working on this (Google, IBM, MSFT, EPIC)

  3. EMR's definitely need a TL/DR (too long, didn't read) section that doctors can take a quick glance at to get a general idea of the patient's condition. This would be best accomplished with EMR software that is integrated into the practice management software, to make it easier on physicians and administrators to manage their patient database. Let's say there's a patient portal where they can log in and access their personal health records. The patient would have a "Profile," ala social networking sites like Facebook. The EMR's could be thought of as a photo album on the patients profile for test results and x-rays and such, but for a brief overview of the patient's medical history, there would be a 'Wall" like Facebook's where doctors would post short summaries and assessments after each visit.
    Here's hoping!

  4. @Leonard, Alexander
    Great points. I think the current EHR vendors may be focussed more on the interoperability portion and less on making the doctor's lives easier. Large vendors with big clients have no incentive to change. Their clients are too heavily invested in their software to change...

  5. I like the idea. Makes me wonder if EMR systems are viewed as providing legal coverage in a litigious society such as ours. I would also imagine that the best EMR systems provide smart documentation modules that can cut down on unwanted or redundant clutter.

  6. A major function of the EMR is to provide analysis, both longitudinal for the patient and aggregated for groups of patients. I am not against summary text but it is not an EMR as it will never carry this critical function.