Sunday, June 5, 2011

Making EHRs More Meaningful for Physicians - Part I

Using Social Media/Networking and Web 2.0 Ideas for EHRs.

While EHRs have a lot of potential, their design could be much better. There is a feeling that the needs of the physicians have been ignored during the design process. It is high time, physicians spoke up loud and clear on their needs.

As more information is collected within the EHR, it becomes progressively more difficult to review it in an efficient manner. This is due to several factors but I am going to focus on just 2 right now:

  • The office visit notes tend to be very long with the meaningful portions buried amongst all the requirements for medico-legal and billing and coding needs.
  • The information is not appropriately tagged or categorized.  For example, when I am managing a patient's reflux disease, I like to look at all the related notes, medications, tests etc. in one place. This would prevent overlooking something and provide better care while saving the physician time.
Web 2.0 means that users create content and help create meaning from the content by appropriately tagging and curating it.  In EHRs while care givers create content, it is not at present easy to make sense from it.  We rely on various system solutions like ICDs and CPTs which are often like fitting square pegs in round holes.  They serve the purpose for everyone but the physicians taking care of the patient.  It is high time, physicians did something to make sense of the EHR data for themselves.  So here is a proposal.
  1. With every note, the care giver will create a short Twitter-like post to summarize the thoughts and plans.
  2. This summary will be tagged with the appropriate organ-system or category (one or more)
  3. The patient's EHR will have an overview page with the (reverse) chronologically arranged Twitter-like summaries from every encounter.  These could be sorted/filtered/searched.
  4. The tags from these summaries would be used to create a wiki where each tag would be a topic and all summaries created by various physicians tagged by that topic would be automatically collated under that header.
Here is a mock-up of what this could look like.  To explore how this works, pause the presentation and click on the various tabs, hyperlinks and tags to see the proposed functionality.
Click here to see the slide set as a flipbook.
Or just take a quick look at the non-interactive images below:
A twitter feed of summaries from encounters.  Each summary is linked to the full note.

Office visit note with Summary at top.  Appropriate tags added.
A Wiki for the GI topic with all encounter summaries tagged with [gi].  Additionally has timeline for GI related decisions.
Medication tab showing timeline of medication changes with links to encounters notes when changes were made.
These are "back of the envelope" designs and clearly need to be thought through in detail.  The concept though should be quite obvious from these.  Any EHR company out there listening?  Someone want to build an open-source EHR based on these principles that will truly help the physician and the patients?  

The astute reader must have noticed the "Part-I" next to the title of this post.  Yes there is more to come.