Tag: EHR

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Let’s call it EHS!

Doctors are widely using EHRs in different clinical specialties and sub-specialties. In a 2018 survey of physicians by Deloitte, only 10% accepted their current EHR systems.  The rest wanted at least one area improved. Different studies have reported mixed findings, and a significant result is reasonably consistent: doctors are not satisfied with their EHR systems, EHR is a place to store data or a digital filing cabinet.

The biggest complaint is that the diagnosis and treatment flow in EHRs does not follow the thought process of a doctor, most times, it is the other way around where the doctor has to follow the flow of the EHR. 

Doctors have to spend time clicking and search around. What is EHR’s competitive advantage if it cannot easily search and display patient information for diagnosis process and treatment plan?

Modern EHR is wrongly defined by its legacy name, R (for the record) does not reflect its role in medical practice, and R also blocks innovative thinking as a solution. We should call EHS (Electronic Health Solution)

The thinking design of EHS must have the capability to support the diagnostic process. In particular, support the providers involved in the diagnostic process and reduce potential errors.

The researchers have described the critical attributes of safe EHS, including:

  • Easy retrieval of accurate, timely, and reliable native and imported data;
  • Simple and intuitive data displays;
  • Easy navigation;
  • Evidence at the point of care to aid decision making;
  • Enhancements to workflow, automating mundane tasks and streamlining work, never increasing physical or cognitive workload.

The thinking design of an EHS must provide a continuous treatment plan function. The treatment plan is a set of actions at a defined period for the clinical objectives of a patient.  Doctors want to track the progress and alter it as it goes along. Especially for personalized medicine, the doctor or case manager must have the ability to allocate a treatment plan and monitor each patient’s process.  Most EHR systems have a treatment plan function but not a patient-specific plan; there is no cohort management function for the case manager.

A thinking design of EHS thinks about the user interfaces to a deeper level, i.e., be intuitive and straightforward. A typical example of a design concept is to bold the data-fields rather than the label fields.  It is simple and makes sense.  Doctors are looking at the EHR screen all the time in daily practice, and they know where the label “Gender” or “Name” is.  There is no need to see the labels in bold all the time. Instead, they need to see the data in bold so that they can glance at it once.

EHR has come a long way but still has a long way to go. It is time to transform from ‘record’ to ‘solution’ thinking. EHS is a solution to traditional EHR, and it is to build a platform for clinical intelligence; it is a tool for formulating personalized care paths that everyone uses.

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COVID-19 outbreak test EHR/EMR

Electronic Medical record (EMR) and Electronic Health Record (EHR) in hospitals are tested by the Coronavirus Disease 2019 (COVID-19) outbreak. An integrated and mature EMR / EHR can be a powerful tool in early detection, fast reporting, rapid diagnosis, strict isolation, and the right treatment.

In China, COVID-19 is classified as Class B infectious diseases; however, it follows the preventive and control measures for Class A infectious diseases. Pre-examination and triage is the first step in preventing and controlling virus spreads in hospitals.

I observed a 3-level pre-examination and triage screening workflows implemented in a hospital EHR system in a private healthcare setting in Beijing for the pandemic control

The 1st level screening occurs at the entrance to the emergency room and the fever clinic. Every person entering the hospital building must wear a qualified mask and receive preliminary temperature checking. Screening information, including fever, cough, dyspnea, and epidemiological history, is recorded. Suspected patients are guided to the fever clinic for further examinations. Patients with negative screening results can enter into the hospital. The triage nurse put a round and colored sticker designed by the hospital on the patient’s coat. The marked patient then has access to other departments. The color of the round sticker is changed every day in a weekly cycle.

The 2nd level screening is to avoid patient gathering. It is conducted by the patient self with the assistance of the triage nurse when necessary. Patients complete and submit screening information in EMR on an iPad. If patients have negative results, the EMR flags a green icon, and then the patient can move in the hospital after a second temperature checking. If patients have positive results, the EMR flags a red icon indicating a risk of COVID-19. The nurse will verify and re-check the patient’s temperature. If Patients have an unexplained temperature ≥37.3℃ will be transferred to the fever clinic for further investigations. If patients have not completed the COVID-19 screening, a blue icon is displayed in the EHR, indicating that preliminary examinations are required.

The 3rd level screening is conducted by the doctor in the consultation room. The doctor checks epidemiological history, body temperature, clinical symptoms, body signs, blood test results, chest X-ray results, and CT results in the EHR, and make a medical risk assessment. The level of risk again links to the color of flags.

This 3-level screening is a real-time workflow and process, it guilds decision of patient allocation and isolation during outpatient service and inpatient hospitalization.

The hospital EHR / EMR system shows the advantages of fast mobile access, connecting care providers, real-time monitoring, review, and tracing of outpatients and inpatients. COVID-19 data are always analyzed and reported accurately.

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EMR, EHR and PHR

Many people do not realize the differences between an electronic medical record (EMR), electronic health record (EHR), and a personal health record (PHR), often use the terms EHR and EMR interchangeably. However, some differences define medical and health apart, distinguish ownership of patient information. 

An EMR is a digital version of clinical workflows that record the process of medical practice. 

  • The purpose of EMR is to document care provided, orders, order execution, results, reports, and other information related while caring for a patient. Documenting must be complete if care was not documented; it did not happen then.
  • The patient does not have direct access to their EMR during their hospitalization. They can, however, request copies of their records after discharge. 
  • Healthcare organizations must comply with the requirements of the local regulations in terms of EMR system governance and management.

An EHR is a digital version of integrated health information about individual patient or population. 

  • An EHR has the capability of sharing and exchanging information across different health care settings via network or cloud. EHR includes a varied range of data, including demographics, medical and social history, medication and allergies, immunization record, laboratory, and pathology test results, radiology images, vital signs, BMI, excises, health risks and outcomes, and insurance and billing information and so on.
  • The patient usually has some access given by their healthcare providers and organizations to view their records. 

A PHR collects, stores, centralizes, integrates an individual’s and family’s health information, share when the patient wants, where the patient wants, and with whom the patient chooses. 

  • PHR should securely manage lifelong personal health information, including subjective data like individual’s care preferences and wishes, data from own wearable devices. 
  • PHR is maintained by the patient, is operated by healthcare organizations. The intention is to provide a complete and accurate summary of an individual’s medical history, which is accessible online. 
  • The purpose of PHR is to maximize individual health benefits.

These three terms reflect the revolution of technology in the healthcare field, i.e., the progress of understanding, acceptance, and embracement of technology in daily practice, the role change of patient. These terms may be defined and used differently in countries and regions. Admittedly, technology has empowered care providers and patient than ever.