Adoption and Implementation of EHR: Optimal Workflow Design

Designing an effective EHR – what Doctors & Clinicians want from digital care records?

Research has shown that EHR’s that are too complex or offered with poor user interface become unpopular quickly. As a Clinician and a doctor with 25 years experience working across two continents (India and UK), I am acutely aware of the competing interests when it comes to use of an EPR. The biggest competitor is the patient i.e. research has shown that Digital Health Records can reduce time spent by doctors face to face with their patients.

The doctor’s perspective: Let us tackle the basic question first, what is the fundamental task other than assessing and treating a patient that a doctor does? Without a doubt, the clinicians need to to document their findings in patient notes and to be able to save these, recall these, and search them when needed. This is their first and foremost expectation from an EHR. Doctor’s spend 7-9 years in training and the last thing they want is an EHR trying to teach them to suck eggs! So the idea that if I was dealing with a patient with a chesty cough means sitting in front of a diagnostic algorithm ticking check boxes and radio buttons, moving from one page to another is highly unpopular and unlikely to go down well. See the Deloitte Survey below, documentation and inter-portability standout the most. Read more on this in these two Articles – Deloitte EHR Survey and a National Physician Poll on EHR findings presented at Stanford.

EHR in India - expectations of doctors

Doctors expectations from an EHR

The Patient Tracker has an intuitive EHR workflow: SOAP

We have designed the PTS so that it mirrors the typical paper files traditionally used by clinicians world over. The paper notes folders will usually have sections differentiated by card separators i.e. front sheet with patient demographics, history and physical examination assessment notes, followed by clinical coding using ICD 10 or 11, and Care Plans written in a chronological manner. The subsequent sections on an inpatient unit would host medication charts, physical examination and charting of vital parameters and the file will culminate with medico-legal documentation of relevance e.g. consent sheets, advance directives, treatment contracts, safeguarding information etc. The core design feature of any EHR at the simplest level will thus include SOAP i.e. Subjective History, Objective Examination Findings informing the Assessment and Diagnosis followed by Care Planning. This is fundamentally what a doctor needs from an EPR.

EHR in India - optimal workflow design

Optimal Design used by PTS – EHR in India

Value addition by Electronic Health Records –

A digital healthcare record will allow for automated outcome measures of different kinds to be incorporated. Such value addition should be done without increasing time and work pressures on the doctor. For instance, our blog Mental Health Module exemplifies a host of clinical rating tools as well as Patient Rated Outcome Measures (PROMS) relating to children or adult mental health disorders of a wide variety that are available with the PTS. Similarly a Pain clinic may include a pain score or an Orthopedic Service may implement Ortho-scores to track clinical progress of the patients. A cardiology provision or GP may have cardiac risk calculators or a tool for confirming correct QT interval calculations on an ECG enabled as a part of the electronic patient record. A Pediatrician would want the EHR to instantly convert weight and height to percentiles and not just the simpler calculation of the BMI which is unreliable under the age of 18.

Significantly, all of this data can be mapped against patient demographics like age, gender, diagnosis, medication used and clinical progress on measures and exported through built-in reporting tools available within a good EHR. Patient Tracker is designed and configured to offer this, and the agile development team can add complex capabilities bespoke to your needs on request. However crucial to success of EHR is a simple, fluid, design of the workflow that allows all such value added work to be carried out separately, in the background by R&D departments without burdening the front-line clinicians.

Dr Adhiraj Joglekar

Next topics: Read about Security Framework in design of an EHR and understand how this is different to Legislation relating to Data Protection in India and worldwide.

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