Getting data from your EMR does not need to be like drinking out of a fire hydrant

Maybe we just need to optimize the fire hydrant

Maybe we just need to optimize it.

“Reading an EMR is like taking a drink out of a fire hydrant, it is bloated with repetitive data” – Keith Kein, MD …was the tweet that led me to Keith Kein’s blog on risks of EHR data in lawsuits.     I would be lying if I didn’t admit that I was irritated by the headline and even more frustrated by the content.   Dr. Kein went on lament that Electronic Health records are systems designed to make billing more efficient, and that in the absence of efficiencies for physicians many are “copy and pasting” from one note to another to add efficiencies and instead often add incorrect, old or repetitive data to the chart.

These are not new assertions, and I have spent many hours sitting next to physicians listening to these complaints and more, as we work to implement new systems or improve existing ones.     In many facilities there is a tension between the clinicians and the administration that gets simplified by one group saying “The Problem is the EHR” and another saying “The problems is how they are using it.”   The truth is much more complex.

The first generation of Electronic Medical records were built to replace a paper process.   The act of transforming what we did on paper to what we do on computers was revolutionary at the time – we have data saved, easily available, legible and yes, codeable and auditable.   Billing is faster and more efficient.     Capturing the necessary clinical information for billing appropriately has been a part of the landscape of American medicine for some time before electronic health records, and was a focus of this first generation of applications.    

We are now in a new and exciting time in the development of EHRs.     We are starting to move beyond the phase of translating the paper process of electronic.     The question before us now is – what is the best technology to practice the best medicine?       This is the conversation that I have with physicians, nurses, office managers and Administrators when we start to talk about build, design and/or optimization.

We know the tools that we have today, and we know that there is great potential within those tools, as well as the potential for growth.     When you find yourself tempted to complain about the process…I challenge you to push that aside, push your paper workflows aside, push your departmental divisions aside and ask these questions:

  • Who are the stakeholders in this process? (providers, nurses, office staff, patients, administrators)
  • What is the data that we need to collect and how will it be used by the stakeholders?
  • How do we make the job of data collection & transfer of information easy for all parties involved?
  • What is the ideal workflow to provide the best medicine?
  • What are the tools that we currently have at our disposal?
  • Can we meet our goals with our current tools and resources?

These are my favorite discussions.     We are often limited in our thinking to what we understand an application to be capable of.   I think all too often we forget to take a step back and explore what will really help move an organization forward and use that as our starting point.   Often times we even find the solution is using our existing technology in a different way, or investing in one area of improvement will improve user satisfaction and in the end help us all provide better medicine.

It is not easy.  In a climate of ever changing regulations, incentive programs, billing models and software updates, we are all to often focused on what is the next big project insead of on what is the right thing to do for this practice, this organization, this health care setting.   

Every conversation should always come back to this. How are we going to practice the best medicine today, and tomorrow?

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  1. 1
    John Lynn

    Great analysis. It’s definitely more complex than what people make it out to be. Plus, far too often in these discussions they like to compare the ideal (ie. no documentation and all the information at your fingertips whenever you need it) instead of comparing against the alternative (paper).

    Although, it does raise an interesting question which I don’t think you addressed. Can you make a beautiful documentation system that doesn’t have a bunch of extraneous distractions (ie. a full page of normals that hide the abnormals) in the current billing system? I agree that many people focus on the wrong things, but focusing on better patient care doesn’t mean that the billing requirements don’t muck up our documentation.

  2. 2
    Litisha Turner, RN

    Hello John and thanks for taking a moment to read our blog. As one of the primary note builders here at Galen, I feel confident in saying that we CAN make a clean and streamlined note that includes all applicable billing documentation. Getting to that point is the trick however. It takes a flexible EHR, a solid understanding of healthcare workflows, practices for documentation and the engagement of physician champions. When we first heard about the move to ICD-10, one of the things we began working on was figuring out how to build a better note, given all of the new requirements. We are proud to say that we have figured out how to do that in a way that is meaningful and efficient, yet doesn’t distract from patient care as a whole.

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