I’ve written before about my use of EMR, and what I’ve heard from some of you. I tend to place blame for a lot of the problems physicians tell me they have with their EMR on the unintended consequence of Meaningful Use (MU) requirements.

In their rush to put the requirements into place and remain or get certified, many vendors added a lot of point and click that satisfied the MU needs, but were not workflow or clinician friendly, leading to a lot of the grumbling I hear now. It’s difficult, however, if you started by building a program based on what you thought you needed (places to store discrete data about a patient), instead of what you really needed (a place to record physician encounters from which data can be extracted and stored meaningfully).

The AMA has weighed in (a bit late IMHO), on what they think are the top challenges and solutions for making EHRs usable. But I’ll mention the eight key points and offer my opinion.

1. Enhance physicians’ abilities to provide high-quality patient care. I can’t agree more. EHRs must be designed around workflow, not create extra steps. It should make every encounter faster, not slower.
2. Support team-based care. With the advent of the Affordable Care Act and the expected and beginning flood of patients, teams are critical – and that gets back to No. 1. The EHR needs to support the team seeing the patient. That means template-driven documentation for routine visits, allowing non-physician providers to take the initial history and document easily and quickly. It also means having the flexibility to expand a narrative note to accommodate the ever-present, “Oh by the way.”
3. Promote care coordination. They nailed this one. Interoperability between EHRs and the growing HIE movement is key, as well as the ability to track every order written from order to result to patient reporting.
4. Offer product modularity and configurability. A one-size-fits-all EHR simply will not work for a surgeon, a family physician and an ophthalmologist. Their needs are very different, and the populations are different. But the EHR also needs to be sensitive to cost. Family physicians, near the bottom of the income spectrum among physicians, also need the most robust systems, able to accommodate all ages and all settings of care.
5. Reduce cognitive work load. This means to me that not only as the AMA states, “clinical narrative is more succinct” but also that clinical decision support must be built in. If data can be stored in the EHR for rapid retrieval and the “best antibiotics for outpatient pneumonia” or the “Epworth Sleepiness Scale” can be asked and calculated before I get in the room, that’s a good thing.
6. Promote interoperability and data exchange. When I closed my practice, we had to lease a high speed, high volume printer to accommodate as the records transfer. The technology did not exist to transfer electronic records electronically. Even with the proliferation of EHRs, the problem still exists.
7. Facilitate digital patient engagement. Facilitating transfer of information between patient and EHR – whether through “open notes,” or data transfer between smartphone, connected technology, or just allowing patients to schedule and communicate online – will be a good step forward.
8. Expedite user input into product design and post-implementation feedback. Allowing users to provide real time feedback as they’re using the technology will help give frustrated users a voice and guide improvement, and improve the technology to improve performance and safety, as the AMA has said.

Well done, AMA. There is much more to be done, but these eight principles are a good start.

Let’s start working with clinicians and convince the techies to really listen. And physicians: let’s start to learn a little about how databases and EHRs really work, so we can help the techies create better EHRs.

Your thoughts? What would you add to these eight principles?