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EMR Hunting: 20 Questions (well…5, plus)

Q) Why is hunting for an EMR like looking for a new smart phone?

A) Because there are a ton of them from which to choose, most of them look and feel pretty much the same, they can all do a lot of the basics, there are some pretty cool features even in some of the less-developed ones, and even the best ones don’t do everything you might want.

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Q) Why is vendor EMR enhancement sometimes akin to moving from a pig pen to a mud puddle?

A) Because when a vendor gives their old users a new feature or a slightly better interface, the users will rave and crow about how cool the new feature(s) is/are, not realizing their lot in life has only minimally improved.

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Q) Why aren’t all vendors offering free online demo tool access where users can “test drive” an EMR?

A) Not sure. I only know that if I’m buying something to “drive” for the foreseeable future which may make or break my bottom line, I sure as heck am not going to pony up after a spin around the block with the salesperson doing the driving. Plus, I’m much more prone to appreciate a vendor who provides such access.

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Q) What makes for a great EMR demo experience?

A) Vendor reps who really know their product, who don’t assume that they know more than their customer, who take the time to try to deliver a personalized experience and not just a rote spiel, and who TRULY understand the value of time to a busy physician.

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Q) What can providers do to enhance their EMR product compatibility?

A) Look for a system “look and feel” that suits you, yes, but also look for a corporate philosophy and history that is compatible with your values. Glitz and sham abound; don’t be blinded by pseudo-science, salesmanship, or “the show.”

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Q) What about those products mentioned in the post of November 30^th?

A) Not forgotten. (And by the way, I really appreciate the Comments and emails I’ve received suggesting products and features I may not mention or even be aware of – thanks, and please keep ‘em coming!)

SRSsoft’s Hybrid EMR – One of the things I like best about SRSsoft isn’t just their new “app store” which allows users to add new parts and pieces in the user-friendly fashion of iPhones and Droids (which I truly, dearly love!) No, perhaps the best thing about them is straight-shooter Evan Steele, company CEO and all-round good guy. Evan actually took the time to personally show me around the SRSsoft block and describe their tool, their new app store, and their pending new version features (very cool!) What really makes him unique in my book, though, is his honest, no BS approach. Case in point: Evan has been rather outspoken in his opinion of Meaningful Use certification and its lack of value to specialists (one of his special foci.) He has maintained a clear vision about wanting to provide physician-friendly tools which are “workflow-driven.” However, as this ever-evolving process has unfolded, he has re-evaluated their corporate stance and will now get on about obtaining an ONC-certified diploma. The value to his clients of such has changed and he is open and frank about seeing the need for providing this and changing his approach. As he gave me a explanation of his changed views, I sensed no sales guy schmooze, just a plain-spoken “I’ve reconsidered.” I like his lack of guile and straight up manner.

Medicity’s iNexx – Well, I’m not sure what to say now about Medicity and iNexx. I have gotten to know several of their corporate bigwigs and really enjoy and respect them. I like their primary product a lot and am very intrigued by their approach with the open source, app-able iNexx (though it’s really still in alpha and not yet ready for prime time.) The recently announced buyout by Aetna is something that makes the physician in me cringe. Nothing particularly personal to Aetna, but after years of aggravating experience after aggravating experience, my overall insurance company Gestalt is, well, probably pretty commonplace amongst providers and not all that wonderful. I do try to maintain the bigger picture view I espouse, but whether it’s Aetna or UnitedHealth Group or MomsAndPops Hometown Insurance, most physicians don’t really feel too good about having more insco involvement in between their patients and them. It’s a “once bitten, twice shy” thing. I read on HIStalk that Medicity would stay as a separate biz unit “under the company’s current management.” I hope so. I really like those folks - and their tools.

So many products, so little blog space. Next up: Fun folks (expanded,) excitement, a true helpmate, the power of views, plus.

To be continued, from the trenches…

“Dreams are today’s answers to tomorrow’s questions.” – Edgar Cayce

Time for the Cheese, Please

“Thought provoking EMR comment. Don't be sparing us the details of the cool features you've seen and which companies are providing the cool features you've found...show me the good stuff!”

That’s a compilation of a couple of quotes from John over at EMR and HIPAA after a recent post here where I mentioned I was starting to find some pretty cool pieces and parts amidst the waterfall of EMR/EHR demos I’ve been drenching myself within of late. I promised I would “stop the tease and show the cheese.” (John requested sharp, but it may be more along a Muenster.)

Four up front caveats:

1) I am in no way receiving any remuneration from any of the vendors I will be mentioning.

2) I have really enjoyed many, if not most, of the people who have taken their time to show me their solutions. Part of me wishes I didn’t have to end up choosing but one answer/company for our office’s needs.

3) While I am certainly keeping self-interest at the fore, I try to consider the needs of my heretofore undigitized colleagues and what my understanding of their needs might include.

4) There’s only one of me and I have a day job (well, often a day and night job,) so I wouldn’t even begin to imply I’ve seen all there is to see – but I’m trying!

OK, here we go, and in no particular order of coolness…

Ultimate Usability

Unfortunately, there’s not a system in existence today that has this feature – yet – but the hands down winner in my book goes to Medicomp’s CliniTalk and its yet-to-be-named Type/Write/Click cousin. Using their medical knowledge engine of “260,000 coded clinical concepts mapped to CPT®, DSM, ICD, LOINC®, RxNorm, SnomedCT®, and other billing codes and clinical reference terminologies,” this middleware allows truly smart data capture, integration, manipulation, and utilization. It’s coming very soon to some pretty good systems which it will help to make great. I’m so enamored with this functionality that I’m doubtful I’ll be able to choose a new system that doesn’t have it incorporated – or at least one with plans to do so. (Seriously, it does for clinical data what I’d always thought a computer should: it adds an intelligence and a level of association-making that a busy clinician really needs while helping to minimize the “Wow, I went to med school to become a data entry clerk for insurance companies” feeling.) Unconfirmed, but I hear Sage Intergy will be one of the first to engage this hyper-enhancement.

Eye-Friendliness

This is one of my personal “gotta be there” criteria. (It was a huge factor in my love at first site with Bond Clinician, the now life-support-plug-pulled Peak Practice.) If my “blink” upon first view of an EMR isn’t one of “OK, that’s kind of pretty,” then I know the demo from there on out will likely only yield ideas for features or functions I might want to see in the other system I do eventually choose.

Prettiest faces in this category are all iPad-ian: Quest’s Care360 and ClearPractice’s Nimble. Right up there, too, is Dr. Chrono, but I admit to enjoying the warm feel of faux leather, even if only digital, which Care360 and Nimble use. This familiar view might even assuage some of the anxiety of docs who are still pen-and-paper bound. (I especially like the slightly askew desktop look-and-feel of Care360, perhaps because my desk is usually pretty askew, too.)

Desktop systems could learn a thing or three from these iPad implementations. I mean, really, isn’t there a whole science about HCI (Human-Computer Interaction) and how to make visual content appealing, productive, and efficient? My take: Many EMR vendors could use a few less Chief Marketing Officers and a few more humanistic computer interface designers.

That said, I have seen a couple of desktop systems worth noting. SOAPware’s EMR has come miles from when I first remember its rather basic layout. athenahealth’s athenaClinicals also has evolved nicely since I joined Inga and John Smalling in a group demo about a year ago in an ill-fated jaunt into product demo reviews. (I liked it then; its look and feel is even better now.)

As this is a long, ongoing, often sleep-inducing process, I guess it’ll have to be a “to be continued.” But, before I go, here’s a few I’ll be discussing next time:

· We “get” the “App Me, Baby” idea: SRSsoft’s Hybrid EMR and Medicity’s iNexx.

· EHR vendor team who seems to have the most creative fun: Nuesoft.

· Most exciting new non-EMR EMR: Mitochon Systems mEMR.

· Best digital office preparation tool: Welch Allyn’s EHR Prep-Select.

· The value of views: DIS.

· Using exo-EMR stuff, mostly iPad apps, as really useful patient education and engagement tools: Blausen Medical’s Human Atlas, Pampers’ Hello Baby – Pregnancy Calendar, CHADIS, and Text4baby. (Pseudo -exception to caveat #1 above: I also like start-up Health Nuts Media for whom I am the unpaid CMO.) Heavy prejudice toward pediatrics, I know, but remember the source here.

· Vendor web sites: what attracts and what repels.

· “The Good, The Bad, and The Ugly” of demos and vendor/client connections.

So, while not meaning to continue the tease as I’m really trying to dole out the requested cheese, I’ll close here with the promise to grate some more fresh Parmesan soon.

From the trenches…

"The early bird gets the worm, but it's the second mouse that gets the cheese." - Jeremy Paxman

Dually posted on HIStalkPractice.com.

Oh…So, That’s Cool…

After my last set of whines and gripes, I have been gifted with a wonderful slew of wake up slaps to the face. There are – thank you, Jesus – some pretty cool new developments in the world of EHRs. I feel as if I have been given a Moses-ian view of the EHR Promised Land and the view up here is pretty pleasant, much brighter than my first assessment may have perceived.

I’ve gotten demos and descriptions of some EHR 2.0- to 4.0-ness that are flat out encouraging. CEOs and development VPs and idea men and sales folks have all shared some very cool new approaches and system enhancements which have me feeling almost giddy with possibility.

I said I wanted to see apps: apps there are a’poppin’. I mentioned my new iPad love (even though as a PC guy from way back it feels almost elicit): there’s more iPad approaches a’brewin’ than I a’knew. I noted WebOS moves so smartly: some EHRs are now a’hoppin’. And, though my desire for EHR “beauty” may still be more a part of the “Promised” than the current “Land,” the scenery is showing some springtime buds a’bloomin’.

So, now that my bipolar swinging is apparent, I have to admit that my prior gripes may have been somewhat stilted, probably secondary to my exogenously-induced IEDD: Impending-EHR-Death Depression. (By the way, if it isn’t yet, I hereby suggest a new DSM-IV entry of just such a disorder; I am certain we’ll see many more such cases in the coming years. Successful treatment of IEDD – for which Xanax helps, I should add – is primarily dependent upon a fast bolus of Innovation and Value: an “IV bolus.” I am blatantly pilfering this term for the new IEDD rehab center I’m founding.)

As I move higher into my mania, I’m almost moved to a mental meltdown by the mention of a not-so-minor bit of minutia: the dreadful awareness of “you can’t have it all.”

Smart pieces and parts from here or there all swim within my mental imagery of the world of EHR possibilities which are upon us. They dance and dodge about in my mind as the number of demos mounts and the differences among them melt into one gigantic “what could be” mélange. I can see the future, the EHR Promised Land, but as many a pioneer’s dissuaders have portended, “You can’t get there from here.” I can see little snippets of the path to the land of EHR Shangri-la, but I can’t see how to tie them together into one consistent path. The road to HIT nirvana is still hit AND miss.

I didn’t want to have to change systems, but now that I’ve been blessed with a deeper view of what’s been cooking on EHR stoves all about – much of it still percolating under boiling pan lids – I’m starting to get a little bit excited about what functionalities and innovations my next system might provide. In fact, I’d place my order right now, if I could P.F. Chang it – you know: one from column A, two from column B, one from column C…

From the curiously intrigued trenches…

“We want the world and we want it now.” – Joey Ramone

Co-posted on HIStalkPractice.com

But What Do I Know?

I've been looking at a whole lot of EHRs and their web sites lately, looking for my "next great system." Maybe they're just starting to blur together in my brain, but it looks as if every single EHR out there will improve my workflow, decrease my errors, increase my productivity, improve my bottom line, get me home earlier, make my life easier, and guarantee my MU bucks. Somehow the redundancy of hype doesn't increase my interest...but what do I know?

Back in 2004, I remember thinking that the majority of EHRs looked a whole lot like Windows 95. Not much has changed. I used to think that most EHR developers would soon learn the value of style, of "eye friendliness" for meeting the wide variety of end user tastes or that at least they'd develop "skinning" for their systems to help solve the problem of ugly EHR user interfaces. I remember thinking how much better they'd all look within the next five years…but what do I know?

I remember when you moved from one medical practice to another, from one type of paper chart to another, and it took all of about thirty seconds to figure out what went where and how to find the info you needed. Seems that the multitude of "modern" electronic charting systems could stand to be reminded of that...but what do I know?

Seems as if every report I receive via fax or hard copy from (fill in the blank) EHR is either way too long and filled with mostly irrelevant "filler" data or way too short and lacking essential, clinically valuable elements. Seems as if very little effort is being spent, at any level, on truly defining what clinicians actually "need" and how to make that information apparent, easily visualized, and perhaps even somewhat standardized when it comes to knowing where to look for any given piece of info...but what do I know?

Doctors used to be paid for their knowledge, for their experience, for their clinical skills, and their wisdom. Nowadays, it seems we're paid mostly for data capture. I think patients still want good “doctoring”...but what do I know?

It may just be me, but there appears to be an increasing similarity between how insurance companies deal with clinicians and how more and more EHR vendors are starting to treat us...but what do I know?

I read that independent providers aren't flocking to EHRs quite as much or as fast as hoped despite the ARRA/HITECH incentives. I'm thinking it might be because of some of the above concerns and just how difficult it is to actually change virtually everything about how you work while you're busy actually trying to do the work...but what do I know?

For myself, I'm also hesitant to make another EHR choice. Having lived through three EHR company acquisition-mergers which eventually led to the Kevorkianization of a really smart, sexy system that was just reaching a respectable maturity, I'm pretty sure more this same digital tragi-drama will happen to many other decent systems over the next few years...but what do I know?

Don't get me wrong; I see systems which do some things very well and I know a whole lot of EHR vendor folks who I think are just plain wonderful. Good people and good intentions are important, but I'm still thinking I want a beautiful system that works as easily as my iPad and as intelligently as WebOS, one that I can start using as simply as I need and which can then be "apped" silly at my discretion, one that is actually as good and as smart as all the hype...but what do I know?

From the trenches…

"Committee - a group of men who keep minutes and waste hours." - Milton Berle

Co-posted on HIStalkPractice.com.