Healthcare Professionals, repeat after me . . .

“I’M AS MAD AS HELL, AND I’M NOT GOING TO TAKE THIS ANYMORE” – I don’t like my EMR, it does not handle my workflow, it does not improve patient care, it does not save time. . . . I refuse to use it.

If any of this sounds familiar, you know you are not alone.

But, the bad news is things are not going to improve unless/until point of service healthcare professionals like yourself put THEIR best practices to work.

It’s hard to imagine that any remote 3rd party would be able to develop a set of best practices for you/your Agency.  And, it’s hard to imagine that you are going to have the time/patience to sit down with your IT department and help them write a specification that will allow them to develop the next generation Ferrari.

So, next time you go shopping for an EMR, make sure it allows end users to map out best practices, same as you are able to use software products like MS Word to write letters. Except that you will have to get IT to help you with any required rule sets that need to be in place and you will need to get IT to build interfaces to various internal and external systems.

Before you go out and sign up for Computer Programming 101, newer EMRs require no programming aside from the two areas highlighted above, so the bulk of the effort to map out best practices involves little more than dragging and dropping circles on a canvas and connecting these with arrows.

Sure, there is more to it than this, but unless you are a solo or very small practice, chances are there will be a process-oriented person within reach who can do this for you.

Alternatively, make a few phone calls and you will have a small army of consultants and facilitators scratching at your door shortly after you put down the phone.

How did we get to where we are? Or maybe the question is even more basic than this and should be rephrased to “Where are we, actually?”

The trouble started with the notion that the purpose of an Electronic Medical Record was to act as a repository for individual patient data the same way EHRs aggregate data across patients and supposedly over time will be able to accommodate transfer of individual patient health information from one EHR to another.

The old “chart” did a lot more, if you could find it.  Once found, you had a reasonable expectation of being able to look back over time to see the complete patient history (data as it was, at the time it was collected, on the form versions that were in service at the time).  You could fairly quickly look over the data and make decisions re services to be rendered to the patient.

Today, you no longer hear the question “Where’s the chart?”- the chart is everywhere, but in many EMR systems you can no longer “view data, as it was, at the time it was collected”.

And, data that is important for decision-making is now mixed up with all sorts of “outcomes analysis” data that typically is not material to individual patient current treatment.

So, where do we go from here?

Firstly, take control of YOUR best practices. Make things such that YOU own and manage your best practices. This will ensure that the data you collect is the data you need to improve the outcome of the patient who is sitting in front of you. The objective is to get to where your workflows work for you, not the other way around. The objective is to see your workflows posting forms you are familiar with and like.

Any other data you end up collecting is, yes, for the common future good, but right now it’s part of Agency overhead and needs to be recognized as such.

Next, put a price tag on YOUR time and then do an ROI on your current EMR and see whether a new EMR would a) allow you to see a few more patients per day and b) possibly allow agency functional departments to run with slightly reduced staffing. Nobody needs to be fired, remember you are in an industry where there are not enough resources to do the work that needs to be done. Re-assess and re-deploy – by all means.

And, if you feel getting all of your ducks in a row might benefit from a couple of days of industry expert assistance to plan and manage any transition you need to go through, just pick up the phone.

However, don’t go to a directory and randomly pick a new EMR – you might find you are “upgrading” to 20-year old technology that is older than what you already have.

And, don’t take it out on the vendors or the government. It’s not their fault, it’s probably just something they ate.  The thing to remember at all times is they are spending your money which is easy to do and does not involve a lot of responsibility.


Management consultant and process control engineer (MSc EE) with a focus on bridging the gap between operations and strategy in the areas of critical infrastructure protection, major crimes case management, healthcare services delivery, and b2b/b2c/b2d transactions. (C) 2010-2019 Karl Walter Keirstead, P. Eng. All rights reserved. The opinions expressed here are those of the author, and are not connected with Jay-Kell Technologies Inc, Civerex Systems Inc. (Canada), Civerex Systems Inc. (USA) or CvX Productions.
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3 Responses to Healthcare Professionals, repeat after me . . .

  1. Your post is spot on. The reason digital physician exists at at is the schenario you mentioned. Our founder is a practicing physician and after searching for an emr that fit the workflow of his practice, he decided to build his own. After running that software for years, we decided to build a multitennant version to offer to other practices. We went live september 2011, and after a good deal of fine tuning we are now looking to bring in practices to our founders club. the first 100 doctors will have an opportunity to shape the future of the system.
    Let me know if you would be interested in a product briefing.
    909-801-4085 michael


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