Bad EHR, Good EHR,
Rich Man, Poor Man,
Beggar Man, Thief.
Dr. Martin Wehlou talks about his own personal experience as a busy physician who is frustrated by having to use really poor software to do his job, while knowing full well that it needn’t be so.
The EHR software we have today is built to document everything you do, but it doesn’t help you one bit to find out what you need to do in the future, and that is what we really need the software to assist us with.
Do you know that the medical records software we use today don’t even have the concept of “disease” in them?
That’s like having accounting software that doesn’t have the concept of “money”. And about as useful.
Typically, a medical record system looks like this, seen from an entity relationship standpoint:
Clearly, the designers must have thought that we doctors are extremely interested in knowing which other doctors the patient has met and exactly when, but this is a huge misunderstanding.
That may be interesting for people arranging cocktail parties, but has very little to do with medicine.
What we do want to know, though, is what ails the patient, that is what health issues he has, so a few of the entities at the top should be related as follows:
This little change in the basic domain analysis has wide-ranging consequences.
First is that the medical record finally starts to work for us instead of against us. Secondly, that we have a channel to feed new scientific discoveries and guidelines to the doctors that need them, and at the right time and place when they need them. Third – we now have a standard, vendor-neutral data model for patient-doctor interactions.
Note that the second diagram doesn’t even contain the entities “doctor” and “encounter”. By that I don’t mean that they aren’t kept somewhere in the system, of course they are, but that they’re not important enough to qualify for a top level diagram in the EHR system.
What are the problems?
There are several serious problems, some of which are caused by current Electronic Health Care record systems (EHR) and some which are left unresolved by them.
- Lack of overview of the patient
- No connection to clinical guidelines, no indication of which guidelines to follow or which have been followed
- No connection between prescriptions and diseases, except very circumstantial
- No ability to detect and warn for contraindications
- Unclear confidentiality borders that make patient privacy difficult to enforce.
What is the solution?
- Make EHR systems “issue-centric”:
We need the “clinical issue” concept in our EHR systems. If the issue concept is present in the EHR, there is no need for every doctor and every actor to keep reconstructing it from derived and deficient data. It’s very easy to adapt the issue templates to cover all the needs of the different actors, simply because it turns out they are all after more or less the same thing.An issue is an ICD-10 code, or an ICD-10 code range, that defines the symptom or disease as such. It contains a clinical guidline on how to diagnose and treat the disease, or how to further investigate it and refine the diagnosis, including differential diagnoses. It would entirely replace the usual medical records in daily use and it would best be presented using a tablet such as the iPad, simply because following links, making choices, and looking up information will be much more important than entering text.
- Develop high quality user interfaces. Doctors should be able to start being productive within a few hours of tearing off the shrink-wrap from the application.
- Use simple, vendor-neutral standards for cheap, universally-accessible, patient-discretionary-controlled data interchange. Patient-doctor relationships can then be empowered using simple, easy-to-use private social networking for healthcare that enables doctors to provide guidance and patients to share their personal experience – anywhere and anytime, and with clear privacy borders.
Martin Wehlou, CEO
Martin has been a medical doctor and a developer for more than 30 years. He was trained in general and vascular surgery, intensive care, trauma, and general practice. He also holds the CISSP and CSDP certifications. He is the main designer and developer for the iotaMed suite, and is one of the co-founders of the company.
- Just between us - Private messaging 1 on 1, group message from doctor to patients.
- Sharing that is so simple - Share your files, your guidance, your experience, your comments.