Where is the innovation??

Altra, BSN, RN · Mar 14, 2015

Have you considered the impact of the multiple layers of regulatory oversight present in healthcare?

Having to produce on demand documentation that demonstrates X, to the satisfaction of the regulatory authority, in a format acceptable to the regulatory authority, limits innovation in documentation, IMO.

mydesygn · Mar 15, 2015

Typically, I find that expectations are unrealistic. An EHR is not Itunes - all Itunes has to do is play and purchase music. So, the software can be very simple and easily maintained.

An ehr has to maintain extremely complex and personalized data on thousands of different people. It has to calculate and warn on changing medications and doses from age 1 day to 100 years, It has to have customized documentation for a variety of healthcare providers from pathologists, child life, chaplains, respiratory therapists, not just nurses and doctors. It has to try to maintain rules and warnings for staff who no longer have the critical thinking skills to carefully review their care before they provide it.

The build and maintenance of healthcare ehrs is enourmous and expensive. Ask yourself why Microsoft and Google failed to get anywhere in the market. Most EHR's cost 70 - 80 million just to purchase let alone millions of dollars each year to the vendor

There is no such thing as stopping supporting a system that contains the health records of 100's and thousands of people. The technology in the 80's still has to maintained and accessible. Unlike Microsoft can't simply decide to stop supporting a version of software (win 98 for example) - they don't have that luxury

Hospitals made multiple attempts to not pay and provide staff to adequately maintain and support the hardware and software - often trying to outsource and failing. That slowness is not the software , it could be a poorly maintained network, servers that lack enough memory and outdated pc's

mariafh · Mar 18, 2015

As a developer of these systems, there are a few reasons that might associated with this. Some have already been mentioned. First, healthcare and its documentation/processes are complex. This industry, with all of its nuances, rules, etc is not simple, much more complex than iTunes, banking systems, etc. The variety of data elements to be supported is extensive. If you look at the HL7 Reference Information Model - you can see how complex the data is, even at a conceptual model. Secondly, this is a highly regulatory industry, which it should be to protect the public. But regulations requires documentation and processes. Thirdly, we are taking care of people. The expectations of system quality is at the very top, which again is should be. Lastly, some of the issues with these systems is understanding the clinical workflows. Although a vendor can do focus groups, hire clinician consultants, etc, it is not the same as having a clinician deeply involved in development. For these clinicians to work most effectively and efficiently as an lead/designer/visionary in the process requires a strong technical background, one which few clinicians have, even those that are informatics specialists. Product development is not hospital system implementation - different set of skills required. Those are just my personal ideas. I am sure there are others. A complex issue often has multiple variables.

CIA2013 · Mar 21, 2015

I agree with previous posters, but also think you need to keep in mind the resources need to keep systems current. Updates (while potentially frequent) are extremely time consuming and require manpower. I know our facility is severely lacking because we have one clinical IT to deal w ALL the various pieces of a large and complex system, plus one IT director to deal w financial applications and one other IT to do other software and hardware. Let's just say it's a challenge to keep things running much less up to date!

mydesygn · Mar 21, 2015

Hopefully, large hospital systems are starting to see how critical it is to maintain adequate staff to support, build and maintain their documentation. One great thing about Meaningful Use money is that healthcare began taking IT more seriously and devoting resources.

I still hear stories of facilities maintaining low inhouse staff to support the EHR. The end users don't know any better and blame the EHR for the facilities failure to have current PC's, servers with another memory, strong wi fi, adequate staff to build and modify documentation and ordering, end users who are invested in the development etc..

But there is also the opposite spectrum where end users expect the EHR to perform critical thinking. I seem to get these requests constantly. I had a physician ask if the EHR could auto-renew their restraint order. When I replied back that the purpose of renewing an order every 24 hrs is so that YOU (a thinking skilled person) will EVALUATE the patient and the continued need for the order. Auto-renewing is no different than have a series order for a patient. I get questions to flag for every conceivable condition and yet they are annoyed by the number of pop ups they have to see.

I generally take the approach that the alert is an easily missed or critical component of patient care that would be important for caregivers - not merely a convenience to prevent YOU the caregiver from reviewing and evaluating the appropriate patient information

I remember with the Ebola scare last year, the very first thing the hospital did was blame the EHR stating the patient's travel information was "lost" by the EHR (which was Epic - I believe) I knew the moment I heard it - that it was not true that most likely it was recorded but simply had not been reviewed by the ER physcian as it wasn't their habit to even take into consideration foreign travel and regards to infectious disease. Can the software flag when foreign travel and fever are documented - yes you can still ignore the flag as another annoying popup. Humans are always the critical piece - no software should replace them.

I recognize the overwhelming amount of documentation and verification that caregivers must do but until they realize that ultimately the purpose of the EHR IS NOT to make you work as a caregiver easier but to make the CARE OF THE PATIENT better then you will consistently focus in the wrong ends. The best builds and solutions I have found come from workgroups that focus on how to get and maintain accurate patient information as opposed to what the system needs to do for me.

The best documentation builds have come from clinical staff who had the right mindset and approach and because they participated in the process of the build , they understood what they were documenting/alerted on and why

Most EHR vendors are becoming better about focusing on ease of use and reducing clicks but that can't be at the sacrifice of accurate patient information.

CaptKris · Apr 5, 2015

Sorry but the above is the exact reason why EHR is complex and cumbersome. Both posters above are defending the systems complexity by saying that it needs to be complex to achieve its goal. "Why can't you understand me, I'm a people person"- Office Space. Even one goes so far as to say that EHR is just for the patient and not for the people that use it. EHR isn't iTunes. Yes because EHR systems invite complexity to sit down at every table and every form in the software. You end up with the most frustrating user experience and worse data. Sorry but iTunes right now can tell me everything about every song out of 9572 songs currently in my library. It tells me at least 44 data fields about each song and I can pull up anything in live search instantly. That's just dealing with the basic music, not including, apps, photos, streaming, billing, store, syncing, suggesting, licensing, renting, movies, TV shows, audio books, podcasts etc etc. iTunes is way more complex than any EMR system, it just presents a user interface that is simple and intuitive. That statement above shows a lack of understanding in the software development cycle. It was designed by people that do not value complexity and understand that simplicity is by far a much more important goal. One button is better than 3. An extra ebola form tacked on the front of some admissions questionnaire that buries a new check box in the middle of a field of 100+ data points isn't the ER physicians fault. It's the EHR staff that designed such a crappy system where they took an important piece of data and hid it in a field of non-relevant data. Sure it's going to fall back on him but EHR is so proud of their ten thousand data points per patient visit that they don't help clinicians see what is relevant. Data Visualization is a concept that is poorly implemented in most EHRs. The software just presents numbers, letters, checkboxes and poorly at that. EHR is not designed with a user experience in mind, or even a patient experience. It's designed around compliance and implemented by people that don't value simplicity. Do you think a focus group came up with an iPhone? or iTunes? you think they said.. you know what we want.. is a phone with one button that will do everything.. oh and apps.. yeah come up with an app store as well.. no. Apple thought of it. they came up with potentially creative ideas and new processes to enhance the user experience while not breaking it in the process. Instead hospital informatics departments are setup backwards. They rely on user suggestions, focus groups, committees, legal council and new legislation to make changes. They attempt to create something to satisfies all disciplines and ends up a watered down product that does nothing exceptionally well. In fact if there is one thing that does work exceptionally well, they will be sure to break it. Informatics has to get proactive and anticipate the users needs. They have to come up with a compelling interface that addresses the patients need to not feel like a piece of fruit in a walmart check out line and the nurses need to care for the patient and not spend all day documenting. No one is suggesting removing the human element, but they're suggesting letting the element work more efficiently. Let the user experience be so good that the effort to accomplish productive work isn't spent trying to get the item to do productive work. That user experience is tailored by the hospital.