The Failure and Success of the EMR—A New Way
By Robert Keet, MD
For the 30 years the holy grail of medical informatics has been the
"electronic medical record." Yet, despite the advance of
widespread computer technology with automation across most other
industries, medical care remains largely a paper process. The failure
of the EMR is based on the fact that physicians receive data from
diverse sources, that data is not digitized, and there is no common
index to unify the data into a single database. EMRs have had to rely
on solutions where all of the clinic data is entered into the system
as part of the clinical encounter. This is time consuming and
interferes with the normal encounter process which is largely one of
personal interaction with the patient.
Physicians in Elysium Communities get a large part of their data
electronically and uniquely identified by patient across the data
sources. While Elysium is sold to the data providers to automate their
process of data delivery, the physicians and their staff can use the
Elysium data to begin to automate the process of data management and
lookup. If physicians add transcription to the Elysium data set they
can create an electronic record that is complete with encounter,
laboratory and radiology data. Adding prescription, allergies, and
problems completes the key clinical data elements.
Scanning and indexing solutions are still too expensive to be
practically utilized to store non-digitized data. However, data access
and data storage do not necessarily need to be combined and physician
offices can take advantage of significant workflow improvement by
using the computer to access clinical data in the office, at the
hospital and at home. Starting with the management of the clinical
inbox, physicians can progress to "chartless" management of
patient calls, prescription renewals, records transfer, and
intra-office communication. A single internet terminal in the
physician workspace can allow significant improvement in the medical
record process with more ready access to data and fewer chart pulls.
Adding terminals to examination areas will further improve efficiency
with less dependence on the paper chart.
The latest version of Elysium is designed to access patient data
quickly and efficiently. From any clinical document, physicians and
their staff can navigate directly to:
- All of that patient's other clinical documents.
- All of the prescriptions written for that patient.
- Detailed patient demographics with a short list of medications, allergies, and problems.
- A cumulative view of the data currently viewed.
From any web location, physician and their
staff can access all of the patients' clinical data quickly and
efficiently. In offices where the data elements are electronically
annotated and managed, the staff can also access the status of results
including the associated instructions (e.g. "Advise patient of
normal result") and annotations (e.g. "Results
normal").
Moving to an "EMR" using Elysium can proceed in a step wise
fashion. First incoming data can be managed electronically in a
process akin to email. Intra-office electronic communication can be
added and encounter data included by signing up for an Elysium
transcription service. Once the bulk of clinical data is Elysium based
the office can begin to use the "Electronic Chart" in lieu
of the traditional chart pull. Committed offices can they add the
electronic delivery of prescription and orders and add allergies and
problems to complete the electronic database.
The digital delivery of clinical data that is uniquely patient
identified along with the tools to manage that data gives physicians
EMR functionality at minimal cost. The holy grail might be within
reach.
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