John Lynn, in his blog Develop Your Own EMR - Your'e Still Crazy! Raises some very good points. For all the reasons in his blog, hospitals and clinics really should leave software to the experts and focus on their patients. They should focus on finding the vendor who offers an EHR solution that lets them do this. BuildYourEMR was designed from day one to enable physicians and their staff to practice medicine the way they want.
I do want to dispute one of John's claims. In his blog, he says "no EMR vendor has focused their EMR on patient care instead of billing". This is not entirely accurate. Furthermore, he states "if you’re in a practice with more than one provider, then you’ll have to start making compromises with your colleagues to match their workflow". This too isn't so black and white. Let me elaborate.
A Practice's workflow can be divided into two categories:
1. Administrative workflow
The administrative workflow and corresponding paperwork needs to be standardized for the clinic at the patient processing level. The steps to receive a patient, check them in, update their history, check their vitals, and prepare them to meet the provider should be consistent at the practice (or at least the specialty) level. Once the provider (clinical) steps are done, the workflow taking the patient from the exam room, complete additional steps such as X-rays and billing, and have them leave the clinic should all be consistent. A good EMR has tasks, lists, and standardized dashboards to allow the office staff to do this as expeditiously as possible. These should be customized by the practice but standardized for all staff.
This is where consistency diverges.
2. Clinical workflow
Forms and Other Favorites: Each provider should have the ability to use their own forms, their own list of favorite medications, favorite diagnosis, and favorite plan items and order sets. The EMR should support configurability at this level too. Every physician has their own unique way of seeing problems, making alerts and task lists. These should be completely configurable by the physician and easily modified over time.
Unique Dashboard: The EMR support dashboards that are unique to each physician. The type and quantity of data on this dashboard might differ by specialty or just personal preference. A well designed EMR will allow the provider to reconfigure this with only a few clicks while preserving the data captured so far and enabling more robust display with each subsequent adjustment.
Robust Documentation: One rule in medicine is "If you didn't document it, you didn't do it." Accurate documentation is very important both for clinical and billing purposes. This is where it is really important to provide complete flexibility to providers. Some providers like to use a SOAP note format for their notes. Others like to use a format based on CMS guidelines and requires HPI, Review of System, Physical Examination, Past History, Plan separated out in individual sections. There are many variations between these 2 formats. Some providers like to start every note from a new template. Some providers prefer to build upon the last encounter note.
Let me illustrate the difference in practicing styles with an example of two of my clients - Dr. Clark and Dr. Smith. (Fictional names used to protect the identity of our clients)
Dr. Clark : When Dr. Clark walks into patient room, he expects the nurse to have completed the Vitals, Review of Systems and Past Medical history. Dr. Clark verifies the nurses information, then conducts the exam. During or after the visit, he updates other portions of the chart. Once he is done, the EHR creates a workflow task for the billing department.
Dr. Smith: Now Dr. Smith who is using the same EHR solution prefers to do nearly everything herself. She even collects the urine samples. She does her own HPI, Review of Systems, Past Medical History, and the Physical Exam. Later in the day, she updates the entire patient chart.
Both of these physicians use the same EHR solution. Both have their unique configuration that lets them spend more time with their patients and much less time with the software. How do we enable this level of flexibility?
The Difference is in the EHR design philosophy
BuildYourEMR takes a different approach. We discuss best practices and options with the providers and staff. We know billing must use CPT codes. We know every physician wants to improve patient safety, quality scores, and most want to attest for Meaningful Use. We work with the whole staff to determine the optimal workflow from the time the patient walks into the clinic to the time they leave. In our EMR, we create tabs that match those in the patient folder. BuildYourEMR allows a practice to configure work-lists targeted to specific users or to specific roles. When it comes to workflow, it is the small details that sometime matter the most and make a huge difference in the speed of EMR adoption. BuildYourEMR allows your practice to configure those minute details including matching the tabs in your patient folder or the rooms in your clinic.
After the administrative functionality is enabled, we work with each provider to create their unique favorites lists. These lists include diagnosis, medications, order sets, and procedures. All are configured for each provider. This is key because an obstetrician will not prefer the same favorite diagnosis, medication lists and order sets as a urologist. We setup the initial lists, then teach the physicians to manage their own as they grow with BuildYourEMR.
We believe EHRs should enable physicians to practice medicine in their own style.