By: Frank Newlands, M.D., Chief Medical Officer
Doctors are inherently creatures of habit and are trained in pattern recognition. Physicians follow set protocols, algorithms, pneumonics and are very astute in patterns such as an EKG, EEG, arterial wave forms, flow loop diagrams, etc. During a patient encounter, physicians follow a set pattern religiously. The pattern consists of reviewing data, documenting and then placing orders. It is essential they believe that EHRs will further simplify this ritual.
Step 1- Data Review. The first thing physicians do before seeing a patient is a quick data review. A good EHR user interface should consist of a compilation of pertinent and relevant data for that encounter. This data should be presented in a centralized place with the appropriate headings. Physicians are looking for a “push” of data instead of the MD having to “pull” the data for review. An example in the paper world is where labs and current medication administration have been placed on the chart. With the development of technology and information exchange; we now have the ability to consolidate information and push it to the end user. In turn, this will allow the physician to assimilate data quickly and prepare for the encounter.
Step 2- Documentation. Documentation or writing a note is an obvious and important step for physicians. Documenting quantifies your data, exam findings, impressions and recommendations. It validates that you were there. It is not only important from a legal standpoint but also important for appropriate reimbursement. Physicians follow certain data collection patterns based on a specific encounter such as taking a History and Physical or documenting a SOAP note. EH’s create the opportunity to pre-populate important data entry and facilitate an easier way to document my patient plan.
Eventually, as EHR data collection increases, systems will become more intuitive and the majority of a physician note will be completed for them. EHRs will deliver common documentation elements such as vitals, labs, problem list, home meds, allergies, directly into a note thus saving time. Additionally, higher reimbursement generally follows more thorough documentation.
Step 3-Order Entry. Order entry is by far the most important piece of a physician’s day. It is how we apply our vast array of knowledge and treat our patients. The physician order is equivalent to a conductor leading an orchestra through Mozart’s Requiem in D minor. The physician order starts the plan in motion and includes numerous moving parts. CPOE streamlines these orders by distributing them to the appropriate department for execution. Computer order entry helps eliminate handwriting errors, filter medications through contraindications and provide decision support, to name a few benefits.
If we can simplify this pattern for physicians by focusing on these three events; the industry will improve the physician’s primary activities and will begin to design user-centered software.
As a practicing physician, I am keenly aware that other physicians enter the world of electronic health records with a sense of caution and optimism. The majority of physicians just want to take care of patients and deliver quality, evidence-based healthcare. The ever-evolving landscape and bureaucracy that is the business of healthcare is wearing on providers as a whole. There is nothing like the thrill of piecing together information and arriving at a spot-on diagnosis. What we dislike is jumping through hoops for documentation and justifying payment for the services rendered.
Today, there is a bi-modal distribution of doctors in the US. You have a large sub-set of older docs that hate the new game and every aspect of how it is played, but they are forced to adapt because they are too far along their career path to do otherwise. On the other hand, you have young, technology-savvy MDs who grew up in this technology-driven age and see the current healthcare game as the norm. They have far too much time and money invested in their education to not play the game within the rules of engagement.
Regardless, of which end of the spectrum the physician may be on, one thing holds true: today’s healthcare is a game, and HRs play an integral part in it , exposing patient data across multiple mediums that will enable physicians to transcend the prior patient experience. The EHR will allow providers to make informed decisions based on transferable and factual archived patient histories. Information exchange makes perfectly good sense. It is something the banking industry figured out in the 90s, so why so long in healthcare? In theory, having the ability to transmit patient data universally will simplify the provider’s pathway to that spot-on diagnosis. In reality, creating a data-exchange platform that is easy to navigate and can capture real-time information is quite a challenge.
With meaningful use timelines and the natural evolution of EHRs, physicians are being tasked to use these systems as they are developed and while data entry is ongoing. This makes for a steep learning curve in a world where time is money and quality outcomes count. As a practicing doc, all I want to do is see patients and get paid fairly for an honest day’s work. In order to do this, I need to learn how to play the EHR game.
Frank Newlands, M.D.