In a previous note, I suggested that physicians are sometimes less than enthusiastic about entering data into EHRs because they do not perceive that these systems are working for them. In other words, EHRs, as currently designed, do not produce value for many physicians other than making the clinical record available electronically (see: EMRs and the Data Entry Paradox; Same Concept Not Applicable in the LIS World). Some hospitals are responding to this problem by hiring medical scribes who input data into EHRs that is dictated to them by physicians and nurses (see: Shift of Hospital EMR Data Entry Tasks from MDs to Scribes). I don't think that this is a long-term solution. Rather I think that the ideal solution is for physicians to demand that EHRs be designed to enable hospital physicians to work more efficiently.
My idea that EHRs should provide more value for clinicians was inspired by Dr. Paul Chang's recent lecture at Pathology Informatics 2012 in Chicago (see: Digital Revolution in Radiology). He referred to the fact that the radiology information system (RIS) he helped to design at the University of Chicago efficiently supports his practice of interventional radiology. It accomplishes this goal by queuing up patients on the basis of various parameters such as urgency and procedure. The system also automatically provides the radiologist, a priori, with the relevant clinical data and images for each patient. In other words, the system enhances clinical workflow. He went on to suggest that pathologists and their AP-LIS vendors should spend more time now focusing on specimen workflow in pathology rather than worrying so much about the integration of digital pathology images into the AP-LIS (see: Digital Pathology Should Leapfrog Digital Radiology’s Adoption Timeline).
It seem obvious to me that the most significant way to turn EHRs into a more useful tool for physicians is to embed clinical workflow in these systems through the use of algorithms. For example, newly admitted inpatients would be queued up on the basis of urgency with suggested lab tests and imaging studies presented to the treating physician based on the admitting diagnosis. Daily patient orders on rounds could be suggested to the physicians on the basis of previous lab test results and radiology reports. Embracing clinical workflow would be no small task but it's the major way I can think of to make EHRs more useful (see: Health Information Technology: Integration of Clinical Workflow into Meaningful Use of Electronic Health Records).
What's the meaning of "no left turns" in the title of this note? UPS drivers are guided on their routes by a computerized system that plans their optimal route in order to efficiently deliver all of the packages in their truck. The route is calculated using algorithms that eliminate left turns. Right turns are more efficient because they do not require the drive to wait for green lights to keep moving (see: Why UPS trucks never turn left). If such an approach is possible for our UPS drivers, why can't we deploy similar computer technology for our hospital-based physicians?
Unfortunately, I think that it's unlikely that useful clinical workflow algorithms will be integrated into EHRs in the near future. The reason is stated in a recent note (see: The Internet as the New Industrial Revolution: Implications for Healthcare). Here is a quote from it:
...[H]ealthcare is the only industry in the U.S. that "solves" its computer problems by using a single, monolithic, inflexible EHR system rather than a set of specialized servers connected on a network.
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