Compelling Useability (and lack thereof)

Ref NYT op-we from last week ...

Call to action to EHR vendors ...

EHR Wish List (part 1)

Here's a starting point for imagining our "ideal EHR:"

• Truly easy to use; intuitive; compelling.
• Improves practice work flow; easily adapts, rather than imposing its own.
• Bullet-proof security (data encrypted; access tightly controlled; activities logged).
• Create prescriptions & transmit to pharmacies (e-Prescribing).
• Facilitate coordination of care. (Reduce time spent collaborating with other providers.)
• Support Quality/"Pay-for-performance" practices driving payer incentives.
• Flag drug interactions and provide other automatic diagnostic alerts.
• Exchange information following emerging standards for health IT exchange.
• Capture patient preferences for HIPAA, data sharing, appointment times, correspondence.
• Send anonymous diagnosis data to public health agencies to support biosurveillance initiatives; this feature must be easily configurable by a normal (non-IT) human.

Some of this may not resonate with you yet, and I may have completely missed a must-have or two. In any case, I hope this gets your "imagineering" juices flowing.

Let's refine, expand, contract and explore these and other ideas to build a vision for EHR 3.0.

Browser-based Health Care Reform

Reforming our health care system has become an increasingly urgent need, and nearly everyone agrees that moving beyond paper medical records is one important aspect of reform. Skeptics of information technology (IT) are plentiful (in health care and elsewhere)--often with good reason. Health care is just like any human activity in that when an IT solution is applied poorly (hard to use, impedes work flow, creates more work), unsatisfactory outcomes are the result. Let's get past the arguments about whether health IT is the place to start with health care reform. Let's just agree that it is one piece of the puzzle, and let's even imagine that if done really well, an electronic health record (EHR) system could be an important component of successful health care delivery reform. An amazingly small percentage of doctors have adopted EHR systems. (Note: Although there are historical differences, Electronic Medical Record (EMR) systems are essentially synonymous nowadays with EHR systems; we'll stick with the "EHR" convention here for consistency, and because "EHR" is the prevailing term for leading-edge systems in this space. You can see the nuanced definitions of EMR and EHR here.) Like any group of humans, there may be some doctors who just don't like computers, but the abysmal adoption rates point to a more fundamental issue: Existing EHR systems are not compelling enough in their usability and value. "Revolutionize" is a bit hyperbolic, but the approach here is somewhat radical. Rather than trying to figure out why ill-conceived, over-priced and poorly-designed systems are not embraced by reluctant doctors, let's find out what happens when we engage a community to imagine the ideal system. I'll get us started with some basic suggestions for features, and we'll use your comments, occasional poll results, and other feedback mechanisms to refine our collective vision.