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May 23, 2013

Should Your Practice Consider a Specialty EMR?

For years primary care settings have been the benchmark for EMR design. By targeting broad clinical workflows and generic user requirements, vendors were able to design a universal product for electronic documentation. However, with time demand for such applications has diminished. Built to deal with routine visits and appointments, the generic EMR model just did not suit the specialist requirements.

Frustrated with system restrictions and blockades, most specialist sought out bespoke solutions. This trend forced the new generation of template driven EMRs. With added customizability, providers were able to configure template designs to a great extent. Established vendors started working with specialist groups in efforts to create specialty specific solutions, changing the market dynamics in the process.

However, despite the surge in specialty electronic medical records, utilization is limited at best. Many organizations still are attempting to make use of generic applications amidst system failures and poor outcomes. Ray Parker an EMR implementation expert explains that there are three main reasons why specialty specific EMR adoption is still low, “One, most specialists are already invested in standard solutions. Two, most specialists would not consider such applications as mature products. After all there are specialties within specialties, and then every specialty has their own way of operation. Three, specialist workflow is too intricate for extensive automation.”

But with that said, specialists can’t keep working around electronic medical records. Healthcare is evolving, and with its sights on coordinated care the industry has to adapt accordingly, embracing reform and technology. As specialist referral providers will need to coordinate with primary care physicians and extend care beyond their walls. Performance driven payments will promote care continuity and increase patient-physician interaction. In order to achieve these measures and deliver accountable care, providers will require health IT.

However, it is not all that bleak. Specialty EMRs have come a long way since inception as most vendors continually work with their users to improve designs and better cater specialty workflows. Intelligent data capturing through the use of picture archiving and communication systems (PACS) and connected medical devices has made the provider job easier. Many EMR vendors now provide interactive animated screens that simplify the diagnosis and documentation process. Templates are updated with relevant diagnosis and procedural codes and workflow is constructed to suit specialized encounters. The EMR market thrives on innovation and given enough time specialty products are likely to make their own mark.

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  • Kevin Hughes

    By way of disclosure, I am a Specialist (Breast Cancer
    surgeon) and I have been developing specialty specific interfaces for
    years. I have been using an EHR for the last
    12 years that is no worse than any other EHR out there.

    Anyone who does not understand the need for specialty
    specific interfaces is likely someone who has only one App on their iPhone, has
    no concept of how computers can be used in the improvement of medical care, or
    is not a Medical Specialist.

    The idea that a single interface would work for all
    specialists is absurd. The pediatrician
    needs to see a different set of data then the neurosurgeon who needs to see a
    different set of data then the cardiologist.
    The workflow of each is different and thus the flow of the interface
    must be different. They use different
    decision support dependent on very different inputs, so the input interface for
    each interface is different and the interface to display the results of the
    decision support is different.

    Think of another life and death enterprise, modern
    warfare. Would you ask the captain of a
    warship and the soldier controlling a drone and the pilot engaged in air to air
    combat to use the same interface?

    The need for specialty specific interfaces is obvious.

    Now, the underlying database (What the EHR SHOULD be) can be
    the same for everyone. That is, there
    may be 20 fields in the EHR for all the ways a cardiologist might record blood
    pressure, and the cardiologist sees all 20, the vascular surgeon may see 10 and
    the internist might just see 3 or 4. There
    is no reason to show the surgeon 20 blood pressure types, nor is there a reason
    to hide those 20 types from the cardiologist.

    We need to move to a modular EHR, where each specialist has
    their own interface but they share a backend database.

    I have written about this as it applies to genetics and
    family history here:

    http://thebreastcancersurgeon.org/2012/06/23/modular-ehr/

    You can see some examples of specialty specific interfaces
    here:

    http://thebreastcancersurgeon.org/hughesriskappsriskmodule/

    In reality, this is fairly easy to institute right now as the
    current EHRs are simply document repositories, not database. What I suggest is that specialists use specialty
    specific interfaces where they can do more work in less time and increase
    quality, and then dump a note into the EHR where anyone can read it. This is what is done by most specialty
    systems now, such as PenRad, and MRS for mammography, Powerpath for pathology,
    Metavision for anesthesia, etc. If you
    tool away those systems and made those specialists use EHRs instead, people would
    die.

    It’s time for the EHR vendors to understand that the goal is
    not to make it easy for the IT department to maintain a single system. The goal
    is to save lives.

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