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Hot Topics | Jul/Aug '14

EHR: My Wish List

In their current form, most (if not all) EHRs kind of stink. I don’t speak from direct experience, as I’ve held off buying and implementing a system to date. But I’ve never heard any of my colleagues say they love—or even really like—their EHRs, and I’ve asked many. The most ardent supporters state that they’ve gotten used to their systems (usually after years of tribulations) and couldn’t go back to paper.

I too can’t wait to dump paper, but what’s holding me back? Well, it comes down to usability and interoperability, or lack thereof. Here’s my take on what needs to be improved—all frustratingly easy technologically—as seen in our smartphones and tablets.

1. Get rid of the mouse.

The interface of the future doesn’t rest on incessant clicking and dragging a mouse hundreds of times per day. The iPad, smartphone, and every POS (point of sale) device, such as restaurant ordering systems, are 100% touch. Voice is in the near future, but we’re not completely there yet.

2. Get rid of all the tabs and scrollbars.

Can you really expect a physician or his or her staff to flip through 12 tabs just to enter (or worse, to review) one visit note? Touchscreens (iPad-like multi-touch, not the lagging PC type) are cheap; make them larger. A good setup would be two screens in each room, one for entering and recalling all of the data and one for imaging. An encounter should be completely visible on one screen. Abolish all scrollbars; let’s swipe like we do on our iPads.

3. Focus all development energy on user interface.

On our smartphones, we can book international, multi-legged flights; enter a complex expense report; and interact with 1,000 connections on LinkedIn in minutes, but it takes 16 clicks to order Tylenol with some eRx system? Not to mention documenting an exam. Build a system that serves the practitioner first and foremost—not government payer requirements.

4. End meaningful use program/incentives.

With billions of incentive dollars flowing from the government through providers to EHR vendors, hundreds of marginal EHR companies are artificially being kept afloat—and their physician-users kept hostages to horrendous software. Only when the incentives and the meaningless checkbox requirements are eradicated will good, efficient, smart software rise to the top and consolidation be seen.

5. EHRs must talk to other EHRs and software products.

Here’s a common example. I found a great digital patient check-in kiosk vendor to replace my clipboard (in fact, I found a few). They provide tablets for patients to check in on: Patients enter their data, swipe their insurance cards for auto eligibility, and then swipe their credit card to prepay their due amount. Unfortunately, this vendor doesn’t yet have a proprietary interface with my cloud-based practice management software (one of the new progressive companies, or so I thought when I signed up). So, I’m out of luck. And this lack of interoperability is rampant in the siloed, proprietary EHR world.

We need to recreate the app store marketplace in the EHR space, where multiple EHR products and software can be seamlessly integrated around a common platform. There’s a reason there are more than 1 million apps in the app stores—it’s because developers only have to write code for two (iOS and Android) or three operating systems. There are still hundreds of competing, non-communicating EHRs on the market.

In the digital health space, I’ve found software vendors that make great online patient appointment software, or cool email/text/call automated appointment reminders and recall, or an extremely intuitive and efficient eRx solution. Unfortunately, these disparate pieces don’t communicate well with each other, and providers are stuck with whatever features their specific vendor did or didn’t design. Or, you can pay for a clunky one-time interface if both parties agree, which may work until the next upgrade renders it useless.

We need a common platform upon which different programs can run. Until this disruption occurs (only when vendors open their APIs—the software interfaces used by developers), the promise of true EHR interoperability and health information exchange will remain elusive.

Tal Raviv, MD

Tal Raviv, MD, is a Clinical Associate Professor of Opthalmology at the New York Eye and Ear Infirmary of Mouth Sinai and the Found and Medical Director of the Eye Center of New York. Dr. Raviv has no financial interest in the products or companies mentioned. He may be reached at (212)889-3550; TalRavivMD@EyeCenterofNY.com.