Many clinicians dislike the EMRs that they are forced to use (see: "Usability Failures" of EMRs Frustate Physician Users; When Doctor's Say "No" to EMR Deployments; Physician Concludes that EMRs Don't Help Patients). In this way, EMRs are different than hospital diagnostic systems like LISs, RISs, and PACSs. Most pathologists, radiologists, and their support personnel would quit their jobs rather than to work without their systems. These systems are designed for, and chosen by, the professionals who view them as a critical work tools. This is not true for EMRs as explained by Katherine Rourke in the Hospital EMR and EHR blog (see: Why Hospitals Can’t Talk EMRs With Doctors). Below is an excerpt from the article:
To me, the following truths are self-evident.
- Hospitals will never have the same priorities as doctors. So, any EMR that works well for doctors probably won’t fit too well into the hospital view of things.
- EMRs that help doctors offer higher-quality care won’t do much to improve a hospital’s bottom line. Why? Hospitals are designed to deal with the results of poor outcomes (if not poor care).
- Hospitals really don’t care whether an EMR is designed well; their goal is to amass and manage data warehouses, not make doctors’ lives easier.
Not only that, hospitals and doctors have dramatically different ways of using EMR systems. For hospitals, EMRs are a tool for managing flow — patients, rooms, medications, nurses, you name it. While no one working there wants to think of patients that way, logistically they’re the key product on a factory floor....For doctors, EMRs are about personal effectiveness — a tool for managing and documenting a highly individualized process....A doctor’s EMR needs to capture their idiosyncrasies and make it easy to find the data they need. If they’re really lucky, medical practices will figure out how to use EMRs to improve care, but over weeks, months or even years. They can’t do that unless the tools they use are flexible, capable of fine-grained views of individual patient data and pretty easy to use.
Now, you tell me. Sure, doctors and hospitals are partners — and maybe some will create Accountable Care Organizations that catch fire — but will they ever reconcile their differing IT needs? I say, probably not. And that means that sharing an EMR will always be painful, fractured experience that doesn’t really meet either side’s needs. Of course, there is one health data solution that could bring everyone onto the same page — an HIE! Sharing the data makes MUCH more sense than trying to share an application, right? But for reasons I suspect you all know already, I wouldn’t hold my breath waiting for those spring up everywhere. It’s a real shame.
EMRs have been designed to support five major functions and allied professional groups: (1) patient management and workflow; (2) billing and resource utilization; (3) physicians; (4) nurses; and (5) pharmacists. Because all of these functions/professionals are supported by a single integrated system, none of them is optimized. For example, physicians and nurses are required to input information that is required to support functions other than their own. As noted above, EMRs are not designed to make doctors' lives easier. Now, you could make the case that nurses and increasingly physicians are merely two categories of hospital employees and there is no need to treat them differently. This makes no sense at all. Their work tasks need to be patient-oriented and optimized. Patients don't select hospitals on the basis of a well-recommended CEO or CIO. They come to a hospital seeking optimal physician and nursing care.
For me, the answer to this conundrum is obvious. Our mega-EMRs need to be broken down into smaller subsytems including those designed exclusively for physicians and for nurses. The data byproducts of these subsystems, in the background, can be fed into other systems like patient management and workflow or billing. In this way, the C-EMR (clinical EMR) modules become analogous to the previously mentioned, and optimized, LIS, RIS, and PACS.
By the way and in closing, Katherine mentions the HIE (health information exchange). Clinicians favor them because they need to learn about the previous histories of their patients in other facilities. CEOs usually support them only under intense pressure. HIEs promote patient mobility to other health systems and this runs contrary to the business model of most health system CEOs. They want to hang on to their customer/patients and consider clinical data proprietary.