…No, I am not talking about the world-famous subway system in London, but rather like to pick up the topic by Dr. Philip Chase on the Physician’s view of an EMR. Dr. Chase describes how a recent visit to his physician revealed that the esteemed healthcare provider spent a lot of time typing Dr. Chase’s answers into an EMR application. The physician’s attention was divided between the patient and the computer system and the entire encounter had the appearance that the EMR itself interfered with the doctor – patient relationship; hence the “gap” between data acquisition and data entry.

Since there’s a lot of talk on EMR’s these days (one recent blog post describes the HITECH Anxiety), I figured it be a good time to reiterate some of the common sense EMR thoughts and best practices.
Doctors don’t want to be IT admins. Correct. I don’t think they have to. Purely Internet-based EMR vendors use this tagline to entice providers to move all of their patient data to a hosting provider, but many physicians are more comfortable with on-premise solutions. Roughly 50% of office visits are delivered by 1-2 doctor practices. Like many other small business in all kinds of verticals, physicians can rely on other (often small) businesses in the IT / Computing world to setup a local system and support a locally running EMR. It’s “my computer guy” who takes care of installing, maintaining, patching, and backing up the systems in any small business, regardless of the industry. Action: Think about hosted vs. on-premise systems and pick the ones that you are most comfortable with.
Usability is key. You don’t want your patients to stop seeing you, because the visits have become impersonal. Don’t focus more than 5-10% of your patient time looking at a computer screen. This will require discipline and some practice. Pick EMR software that lets you work from selection lists and templates rather than free text. Practice some typing (if that’s new to you) and have a vendor demonstrate the speed of documentation and order entry to you.
Devices play a big role. Bigger than you think. Vendors bombard you with different options. Everything from regular office PCs, laptops, tablet PCs (including the Apple iPad), to computers on wheels (COWs) are options. Depending on your practice setup, one or more of these may fit. Here are some thoughts: Don’t set up your devices statically (that would require you to turn your back on the patient on occasion). If you go for wheeled devices, make sure they are not clumsy or blocking your space and movement in the practice. Ensure that wireless networks reach all your exam rooms and provide good signal strength. Consider a tablet device as you can carry it around. Be mindful of the device often occupying at least one of your hands that you won’t have avalailable to examine or treat the patient. Some devices with smaller form factors are said to fit in a lab coat. Try it before you buy! Consider the devices battery life and screen size. Action: Try the different devices in conjunction with the short list of EMRs you’re considering. Some vendors have specific user interfaces for mobile devices or iPads that improve usability when using a multi-touch interface.
Multi-user environments pose special challenges. If you have more than 1 clinical user or running a group practice, consider the fact that physicians will physically move away from a device and into the hallway or next exam room. Unless you choose portable devices, consider fast log off and log on modalities and session roaming. The latter can be achieved through application and desktop virtualization, where your application executes centrally and the “terminals” in the exam rooms and hallways just provide interactive access to the application.
Offsite usage. Nothing is more annoying than not having access to a system when you need it. Ensure that your system has secure offsite access built in. In most web-based EMRs , you should be covered. More elaborate systems may require app or desktop virtualization where the apps and data stay securely tucked away in the data center (or data closet, depending on your size) and allow your users to connect securely over the Internet to the user interfaces of the apps. Action: Discuss those options with your “computer guy” and your EMR vendor.

I plan on sharing more specific virtualization best practices with you in the upcoming weeks and months. Please let me know if there are specific topics you would like to hear about.

Florian
Twitter: @florianbecker
Ask the Architect – Everything Healthcare
Tech Target Blog – Virtualization Pulse