Contest Pits Electronic Medical Records Against Pen and PaperBy M.L. Baker
On Tuesday and Wednesday, nineteen companies selling EMRs (electronic medical record systems) were each given seven minutesthe time clinicians generally need to document a patient visitto show their product. The event, called the Clinical Documentation Challenge, is now in its sixth year.
Electronic systems are gaining ground, but paper was still faster than IT about six out of seven times at this year's Toward an Electronic Patient Record conference.
Most of the time, the clock ran out before EMR systems could document plans to treat a patient. But the clinical commentators who reviewed each demonstration stressed that time should not be the only consideration: Physicians also should look for the ability to quickly view patients' history or print out personalized information for them.
"The bar of entry has risen," said Barry Blumenfeld, who has been a clinical commentator for the past three challenges and helps run clinical informatics research at Partners Healthcare System Inc. Both the number and quality of participants reached a high point this year, he said, and the set of functions common to all EMRs expanded.
Particularly striking has been the increase in structured documentation, a necessary first step to being able to aggregate and analyze data. "Three years ago, that was the exception rather than the rule," he said.
Dinesh Pai, director of business services at Novant Health, said the most useful part was being able to watch and discuss products with colleagues also attending the conference. But he said he was frustrated that they weren't very realistic. Often people other than physicians gave the demonstrations. Better than the demonstrations, he said, was the "hammering" following each.
Blumenfeld and Thomas Sullivan, past president of the Massachusetts Medical Society, provided these reviews. Their attitude was similar to that of a demanding teacher critiquing a rough draft of a student essay. They heaped praise on vendors for braving a public audience and for specific design features; then, they used each demonstration to highlight general considerations for choosing EMRs.
"The downside of rapid documentation means you can rapidly make errors," Sullivan said after a minor complaint was documented as a mock patient's primary reason for coming to the doctor. In another instance, the commentators suggested that a physician could get lost hopping around a screen.
Perhaps the most general consideration is that specifics matter. More than one person compared buying an EMR system to buying a car. The amount purchasers can spend varies greatly; some care more about comfort, others reliability and still others, style.
The difference is that physicians are probably more familiar with cars. Robert Dichter, president of Optimal Practice Solutions, advises physicians choosing EMRs. "Many people go with what their friends have. It may be perfect for other physicians in your community, but it may be totally wrong for your office."
At a panel preceding Wednesday's Clinical Documentation Challenge, experts urged office managers and physicians to articulate their precise needs. Groups will have different demands for e-prescribing, for integration with billing and administrative software, for connectivity with other entities, and for remote access. Also important is whether a vendor has a strong local presence and the vendor's reputation for service.
First, clinicians and office managers need to figure out what specific problems an EMR system might alleviate, and they must valuate all systems with that problem in mind. Scripted demos are unlikely show how an EMR will work at a specific institution, warned Lisa Anne Bove, a manager at CapGemini.
For example, she said, a practice needs to know how the system functions for its typical patients, so smart customers should ask to see a demonstration for, say, an octogenarian with several medications. "If they can't show you that," she said, "then they can't do that."
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