Friday, June 17, 2011

Making EHRs more Meaningful for Physicians - Part III

Context Sensitive Right-Click (Control Click) Menu


Click on the full screen option (lower right corner) to experience this slide show in interactive manner:

Suppose you see a patient with an elevated creatinine level.  You have access to the electronic health records with all the medication administration records and imaging tests.
You try to see if this is a baseline value or a new elevation.  You pull up a range of creatinine values and see that the level has been fluctuating but is overall higher than what is was 1 year back.
You look for any insults to the kidney like contrast media.  You go to the imaging tab and look for all tests that had IV contrast media.  So you sort all the radiology test by date range to find a test that might have occurred prior to the rise in creatinine.  You then go through all the historical medications that could have been started prior the the rise in creatinine.
Even though all the information is there in the EHR which is a big improvement over the days of paper charts, it takes you 10-15 minutes to find all this information.

What if there was a context sensitive right click menu for things like lab values and medications that did this work for you?  Actually make the physicians job easier and improve care?  Instead of physicians just entering more data into the EHR, they actually benefit by getting organized data back from EHRs?

Some examples of such right click menu items might be:

Medications
–Start date
–Dose change date
–Stop date
–Stop reason
–Started/stopped by
–Indication/associated diagnosis
–Timeline of medication/class
–Timeline of associated labs (if appropriate) e.g. TFTs for levothyroxin, or amiodarone etc.

Lab results
–Previous n readings
–highest/lowest/mean/median
–Graph of values on timeline
–Links to notes with related diagnosis (e.g. hypothyroidism codes for TSH) arranged on the timeline
–Links to meds/procedures that might impact the value on timeline (e.g. for TSH – show when amiodarone was started, for Creatinine – show when CT with contrast done, when aminoglycoside started etc).

So what would this look like:
Note: The slide show auto-advances.  Once you are on slide 2, Pause the show by clicking the Space bar,  follow the instructions at the bottom of the slide.  There are just 3 slides total.
This is just a simplified example.
Obviously some background work would need to be done before this can happen.  Thus we would need to identify the appropriate menu for lab tests and medications.  In addition, we would need to identify common events that are connected to each lab or medication.  I would suggest that there are probably a handful of lab tests - each with a handful of events that we can start with.  This would prove helpful in the vast majority of clinical settings.  As time passes we can make this more detailed and cover more tests and medications.

As a physician I and often faced by a patient who says, "But doctor, all the data is in there, in that computer!" The patient is often right (except the data is on a server somewhere) but what most non-clinicians don't understand is how many clicks and screen views it takes to make sense of all this data!