Electronic Medical Record: it’s time to change course!


Healthcare IT companies are investing in new Electronic Medical Records, but not really innovating. It’s time to move away from the old patterns and change the approach.

The “recipe” used by IT companies to create an Electronic Medical Record is the same as it has been for many years. Let’s look at the ingredients in a critical way and, above all, let’s see if there are other more interesting and useful ingredients.

Each new software is usually created with a state of the art or fashion development tool. Nothing to say about this even if there is still little attention to the “mobile first” paradigm and to the user experience that is usually designed by developers according to their ideas and their needs.

The focus of Electronic Medical Record remains the search for maximum flexibility and configurability, two key principles that represent the main goal of designers and developers. This goal stems from the need to meet the customers’ requirements, extremely changing often on marginal or secondary aspects, such as the presence or absence of certain fields or their location. This attitude is in turn determined by the fact that Electronic Medical Record focus on data and functions, much less on the decision-making and clinical processes that the doctors and nurses employ in the care and assistance of patients.

The attention of the designers is turned to the data, often treated in an abstract way, without entering the merit of their meaning and their use. A laboratory test is, for example, a class with universal attributes and methods. A blood sugar is, in this logic, equal to creatinine or white blood cells (data neutrality).

The functions that the designers carry out are conceived in order to present the data and to allow its introduction, also in this case without differentiations. The functions allow you to access pages that contain a series of data, sometimes graphs. When the customer requests a page optimised for a specific purpose, the team that implements the medical record takes advantage of the software customisation and configuration capabilities avoiding, in many cases, to write ad hoc code.

The Electronic Medical Record therefore consists of a series of widely configurable pages. Some functions, on the other hand, are developed as applications, for example the detection of vital parameters or the prescription of drugs.

Even in these cases, however, the approach is always focused on the data, there is no intention to go into depth and study what the information really mean, what clinical concepts they express, how doctors interpret and use them in their decision-making process. The Electronic Medical Record is a container of information designed to document the activities of doctors and nurses.

But, to return to the metaphor of the recipe, which ingredients would make Electronic Medical Records more “appetising“?

A doctor, in treating a disease once a diagnosis has been made, defines an objective (which may be the disease remission or its containment), sets a therapy, observes aspects, monitors certain parameters and verifies the occurrence of complications or side effects.

In the current Electronic Medical Record, the doctor does this job by manually introducing the therapy and reading, on several pages, the information regarding parameters to be checked, observations and side effects. The objective is almost always implicit and is not foreseen in the software.

An advanced Electronic Medical Record could manage real treatment paths, suggesting doctors the most appropriate choices, presenting the information in an organic and structured way, activate controls and calculate outcome indicators. For the most common pathologies, which then represent 80% of the cases of many hospital wards, an advanced health record could assist and help doctors and nurses in carrying out their work.

For a patient with comorbidity several treatment paths could be combined, avoiding duplications and overlaps.

The Electronic Medical Record must therefore evolve from the concept of a data and page manager to an expert system capable of managing clinical processes and treatment pathways. This transformation would lead to a large increase in the value of Electronic Medical Record and would, however, require a profound transformation of the professional mix of health IT companies.

It’s time to think about Electronic Medical Record in a new way!

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