The future with electronic medical records: Effective, flexible, affordable
Hospitals, physicians need systems that share information, require less training, reduce log-in headaches
Published: July 12, 2006
Private practice physicians within a hospital are in an odd position. They don't work for the hospital, but without them the hospital would find it difficult to remain open. Because physicians rarely are tied to any one hospital, they might visit several hospitals during the course of a day or week. And at each hospital, physicians have to work within that hospital's clinical information system (CIS).
Clinical information systems and electronic medical records are used in hospitals and physician offices to record information about a patient's condition, the treatment course, any prescription drugs the patient is taking (or should not take), vital signs, and so on. These systems have great potential to improve access to key healthcare information, boost patient safety, and reduce administrative costs.
However, the hospital setting holds a number of challenges. Consider a physician who, during the course of a day, visits two, three, even four hospitals to care for patients. Chances are, each hospital has its own proprietary system. It simply isn't feasible for a physician to be fluent in every system out there. So the work slows down as the physician tries to remember how to enter or find a particular piece of patient data.
Pitfalls of hospital clinical information systems
In some cases, systems are so poorly designed and introduced that physicians refuse to use them. In 2002, at Cedars-Sinai Medical Center, physicians were so unhappy with a new order entry system that they forced the hospital to abandon it. In the worst cases, real harm can be done. Two studies in 2005 (one published in the Journal of the American Medical Association and the other in Pediatrics) indicated that poorly designed clinical information systems actually can lead to an increase in medical errors. This is ironic given that these systems are intended to reduce errors.
Many of the systems installed in hospitals in recent years are not only proprietary, they can be horrendously expensive. It's not unusual for a 500-bed hospital to spend $150 million US to install a clinical information system. And hospital CIOs can tell you that the cost of acquiring such a system is small in comparison to training costs.
Imagine the expense to pull hundreds of highly-paid, in-demand clinical workers (from physicians down) from their responsibilities and put them through many hours of training. And keep in mind that training might be duplicated by physicians when they work at other hospitals. Physicians already commit time and expense to acquire and learn how to use the clinical systems in their own offices.
An alternative: Design systems around physicians
It would be ideal if physicians could walk into a hospital and use the same password and log in that they use at other medical facilities. They would see an intuitive, familiar interface that has data about patients from other hospitals or from other doctors the patient has seen, whatever is relevant. As a bonus, such a system could be rules-based, depending on who signs in. Physicians could choose from a set of options about how to use the system. Nurses could choose from another set of options. Pharmacists and other medical technicians could choose from a third. This ideal system could be based on software that is more intuitive and adaptable than many systems on the market today. And every system doesn't have to be identical or part of a larger system that attempts to tie all hospitals together or handle all tasks with a single company solution.
Such a solution is already in use by tens of thousands of ambulatory physicians who work in practices outside the four walls of the hospital. Called electronic medical records (EMR) systems, these systems streamline and automate the everyday activities of clinicians such as documenting patient visits, ordering lab tests, viewing results, and billing for services. EMR systems also enhance patient safety by alerting physicians when they fail to follow best-practice guidelines or prescribe a drug that can cause an adverse reaction in the patient.
TouchWorks EHR software designed by Microsoft partner Allscripts is one example of how ease-of-use and intuitive design can benefit the healthcare industry. Designed to work with mobility devices such as Pocket PCs and standard desktop and notebook computers, the Web-based TouchWorks EHR enables a physician to create electronic patient records in his or her office, and then easily access them using the Microsoft Internet Explorer Internet browser in a hospital setting—either through portable computers or a personal computer. Patient records, charges, drug interactions, lab orders all can be easily recorded and saved.
TouchWorks also helps control costs by enabling physicians or physician groups to purchase only those modules that meet a particular business or clinical need.
TouchWorks isn't designed to replace the big, hospital-centric systems now found in many hospitals. But it shows how a flexible, modular system that is centered on physicians' needs can begin to streamline and simplify how medical records are collected and kept. And TouchWorks doesn't try to force all clinics to use the same suite of products. As Dr. Peter Geerlofs, Allscripts chief medical officer, tells me, "The monolithic approach doesn't meet market demand. The world is going to a best-of-breed place, where people can use the best products for particular clinic needs. In TouchWorks, our architecture supports a plug-in concept, so it can be used with third-party devices and software, or particular bits of code."
In the years to come, we could see adaptable systems that work across geographic or hospital system lines, what Geerlofs calls a decentralized federated model. In such a system, all clinical data stays within the hospital or physicians' system that first created it. But it's tracked by some type of record-locating service, which knows where information for particular patients is stored and enables physicians to call it up when needed (provided security parameters are met). This way, even records in New York can be read by physicians in California should a patient move or end up needing medical services far from home. Now, for example, Allscripts markets a records tool called HealthMatics ED in use by over 150 emergency departments nationwide. The data can be linked between hospitals in a community, making it faster and easier to recognize emerging problems such as a widespread virus.
Thanks to initiatives now underway to make every electronic medical record interoperable, no matter what hospital a physician visits, he or she can quickly figure out how to use it, and perhaps be able to take advantage of a common log in. I compare this challenge to that of creating airplane reservation sites. All of the major airline and travel sites look a little bit different—sometimes a lot different. But they all work very much the same. And once you use one, it's a safe bet you can use the rest. Electronic medical records systems can profit from this example.
Microsoft tools offer connectivity and a common interface
Microsoft has already created a number of software products that help make it possible to develop flexible, affordable, and more intuitive clinical records systems. Microsoft .NET Framework for connected healthcare Web services, for instance, enables a wide range of data-keeping systems to exchange information. Microsoft Pocket PC and Tablet PC technology help physicians take information with them and access it when and where they need it. And Microsoft Office products, such as Microsoft Office InfoPath—along with Microsoft SQL Server and other data management products—benefit from a consistent interface that makes them easily accessible to new users, reducing training and improving productivity.
Microsoft sees a future in which a physician in a hospital calls up a patient records and instantly sees a dashboard of relevant information drawn from all the patient records going back many years. It can require a lot of coordination to make this happen, but the tools are becoming available now. Meanwhile, Microsoft is working hard to help its partners improve the clinical systems being designed today, while building a road to a future where healthcare information is seamlessly connected across the entire healthcare ecosystem.
 | Dr. Bill Crounse, M.D.
Dr. Bill Crounse, M.D., is senior director, worldwide health for Microsoft Corporation. Dr. Crounse is responsible for working with industry partners and healthcare organizations to help them benefit from using Microsoft technologies and solutions. Prior to joining Microsoft, Dr. Crounse was vice president and chief medical information officer for Overlake Hospital Medical Center and the Overlake Venture Center in Bellevue, Wash. Also, read Dr. Crounse's Healthcare Web log to get more insights into the latest technologies and trends in the healthcare industry. |
