College of American Pathologists
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May 2008

Raymond D. Aller, MD
Hal Weiner

How curbing clicking may boost benefits of EMRs How curbing clicking may boost benefits of EMRs

“Clicking takes much longer than flipping.” And that, says Lyle Berko­witz, MD, is why electronic medical records should be redesigned to be more efficient.

EMR systems do not take full advantage of the organizational functionalities, search proficiencies, or visual capabilities of computers, says Dr. Berkowitz, clinical associate professor of medicine, Feinberg School of Medicine, Northwestern University, and medical director of clinical information systems, Northwestern Memorial Physicians Group, Chicago. (Dr. Berkowitz spoke about EMR inefficiencies at the Physicians’ IT Symposium at the 2008 Healthcare Information and Management Society conference, in February.)

Doctors are comfortable with paper charts, Dr. Berkowitz explains, because they can be reviewed so easily. Lab results, for instance, are often printed and clipped to a paper chart, so the physician can quickly review the results and look at the last note or compare them to old results by simply flipping through a few pages. “A lot of analysis and scanning is going on during this process, but it is all at virtual speed in the physician’s brain,” he says. The physician finishes the review by initialing the front page of the results, writing or stamping an interpretation on it, and putting it into an outbox for an assistant to complete and file.

“In a typical EMR scenario, however, the same workflow may take much longer because each step requires extra clicks and scrolling,” Dr. Berkowitz continues. The physician must first execute a series of clicks to reach the results section in his or her EMR. Then he or she may have to click several more times if the results for various tests are grouped separately for the same patient. And if the results section does not clarify whether the tests are finished or pending, the physician will have to go through another series of clicks to verify that all orders have been completed, Dr. Berkowitz says. Additional clicks may be necessary to access a flow sheet that allows the physician to view past lab results and compare them with current results. Then the physician must document what he or she will tell the patient and the method of notification by clicking to access another page and typing in the information. “Finally, even more clicks are added if the physician decides to write something in an electronic sticky note so the information is readily available for the next patient visit,” he adds.

“This is quite simply a waste of our time,” Dr. Berkowitz says. This workflow process may even hurt quality, he continues, since a physician’s analytical thought process will be interrupted by the effort of repeatedly clicking to access information from different areas of the EMR.

So how to solve this problem?

“Create a system that gives the physician everything they need in one place and that emulates the thought flow they use to make a decision,” Dr. Berkowitz says. The EMR system should have a “results dashboard,” which would allow a physician to immediately visualize lab results, prioritize them, and act on them. The physician should be able to quickly clarify which test results are completed for each patient and which are pending, perhaps by holding a cursor over a designated area or having a color-coded icon appear next to the patient’s name, Dr. Berkowitz explains. A second color-coded icon could represent whether results are normal or have minor or critical abnormalities.

EMR systems could also help prioritize lab data by comparing the test results to normal ranges or weighting certain tests as more important than others, or both, he says. For example, a hemoglobin abnormality would be weighted as more important than a chloride abnormality. “The result is that the EMR has helped the physician easily see how to prioritize the results—all with no extra clicks,” Dr. Berkowitz says.

Furthermore, a physician should be able to click on a patient’s name to see—all at once—current and old test results, current medications and diagnoses, and perhaps even a summary of the most recent office visit. Rather than appearing as numbers, the test results might appear in graphical format, making it easier to put such data on one easily accessible page, Dr. Berkowitz says. This expanded results dashboard, he continues, would also allow the physician to sign off on lab results, choose the appropriate interpretation (normal or abnormal results), and make a notation of the next step, such as notifying the patient, changing a medication, or scheduling an appointment. “And, of course, performing any of these action items creates automatic documentation that is recorded in the chart,” he adds.

So how to get there?

Vendors need to view workflows not as individual tasks, but as a series of related tasks combined with thought processes that allow users to interpret data, draw conclusions, and make decisions, Dr. Berkowitz says. And they need to pay more attention to the wants, needs, and frustrations of their current clients, rather than focusing on the requests of potential customers who use paper-based systems.

Also shaping the future of EMRs are organizations such as the nonprofit Szollosi Healthcare Innovation Program, of which Dr. Berko­witz is program director. The orga­ni­zation is “creating prototypes of new user interfaces to help stimulate vendors and others who are developing the EMR systems of the future,” he says.

The end result, Dr. Berkowitz concludes, may be an EMR that looks very different from current paper or electronic systems. “This may be scary for vendors used to showing physicians something that looks familiar,” he says, “but vendors will be much more successful if they can move away from the paper-based paradigm and take real advantage of computers.”

bullet Cerner to market Wyndgate blood management systems

Wyndgate Technologies, a division of Global Med Technologies, has formed a strategic alliance with Cerner Corp. under which Cerner will mar­ket Wyndgate’s blood management systems.

Under the arrangement, Cerner will interface Wyndgate’s blood management software modules with its Millennium suite of laboratory information systems.

Wyndgate’s products and services are used to manage more than 27 percent of the U.S. blood supply, the company reports.

Wyndgate Technologies, Circle No. 186
Cerner Corp., Circle No. 187

bullet Misys and Allscripts to merge

Misys Healthcare Systems has announced plans to merge with Allscripts, LLC. Misys will own a majority of the combined company, and Allscripts executives will run the operation.

The newly formed company, called Allscripts-Misys Health­care Solutions, will support and maintain all existing Misys and Allscripts products. It will be based in Chicago. The combined company will have a client base of approximately 150,000 U.S. physicians.

Completion of the transaction is based on shareholder approval and other conditions.

Misys Healthcare Systems, Circle No. 188
Allscripts, LLC, Circle No. 189

bullet Application for monitoring client service levels

Netlims NJ, LLC, has launched AutoCRM, a customer relationship management application that allows reference laboratories to proactively monitor their client service levels for every account.

AutoCRM, which is integrated with Netlims’ AutoLims product suite, electronically tracks client requests and complaints, as well as pro­gress for each task, and provides client and employee centric displays. The application prioritizes and categorizes tasks, which are assigned to users with a due date and filters for work lists. General messages promote the sharing of information in client services, and users can perform a text search to locate items.

Netlims NJ, LLC, Circle No. 190

bullet Fletcher-Flora marketing connectivity software

Fletcher-Flora Health Care Systems has released its FFlex eLink clinical instrument connectivity software for small physician office laboratories.

FFlex eLink is designed to connect a laboratory’s clinical instruments and an electronic medical records system, practice management system, or other host system. The software not only accepts and transmits data, but also provides an interface that allows users to define tests and reference ranges, approve or reject results, and monitor real-time instrument logs.

Fletcher-Flora Health Care Systems,
Circle No. 191

bullet Flash drive tool to transfer dictation software licenses

Royal Philips Electronics is offering a flash drive tool that allows users of its dictation software to upload their software licenses to any computer.

Users insert the tool, called USB Smart Key, into a USB port on a computer. The key continuously indicates license status via LED color coding. The key also contains a 30-day crash re­covery license.

Royal Philips is packaging the tool with its SpeechExec Pro Dictate, Speech­Exec Pro Transcribe, and Transcribe software.

Royal Philips Electronics, Circle No. 192

bullet MCN releases new version of policy management system

MCN Healthcare has launched version 2.0 of its Ellucid Policy Manager policy management system.

Policy Manager version 2.0 offers a redesigned user interface, streamlined system for defining approval processes, advanced reporting features, new authentication tools, and detailed user logs.

Ellucid Policy Manager is an electronic repository of policies and procedures. The system automates the process of reviewing, revising, approving, and archiving health care policies and procedures. Users with online access can review, edit, share, and approve documents from virtually any location.

Policy Manager is a hosted solution, with MCN providing the application support and maintenance.

MCN Healthcare, Circle No. 193

Mediware Information Systems has licensed its HCLL transfusion blood management software to the following entities:

  • PeaceHealth, a network of community-based health care facilities serving Washington, Oregon, and ­Alaska
  • Providence Hospital, Southfield, Mich., for use in its St. John Health Novi Hospital, slated to open in July
  • AtlantiCare Health, Egg ­Harbor Township, NJ, for its Egg Harbor Township Clinical Laboratory.

Mediware Information Systems, Circle No. 194

A.O. Fox Memorial Hospital, Oneonta, NY, has contracted to implement McKesson’s Horizon Clinicals suite of health care information technology solutions to create electronic health records for its inpatient and outpatient business.

McKesson Corp., Circle No. 195

Ontario, Canada-based Lake­ridge Health, Rouge Valley Health System, Scarborough Hospital, and Sunnybrook Health Sciences Centre have selected mTuitive’s xPert for Pathology synoptic reporting solution to meet Cancer Care Ontario’s 2008–2009 CAP/CS aligned data standards for pathology reporting. The standards were developed by Cancer Care Ontario in conjunction with the College of American Pathologists Cancer Committee, Centers for Disease Control and Prevention, and American Joint Committee on Cancer.

mTuitive, Circle No. 196

Vachette Pathology has signed a contract for its practice management services with Williamsport (Pa.) Path­ol­ogy Associates.

Vachette Pathology, Circle No. 197

Dr. Aller is director of automated disease surveillance and team lead for disaster preparedness Focus B, Los Angeles County Department of Public Health. He can be reached at Hal Weiner is president of Weiner Consulting Services, LLC, Florence, Ore. He can be reached at