Building a Better EMR

Aug 5, 2013, 9:43 AM, Posted by

Doctors examine a patient at a clinic.

As co-founder of ElationEMR, Kyna Fong and her brother Conan hope to revolutionize the way physicians use electronic medical records (EMRs). In this blog post, Fong, a former Robert Wood Johnson Foundation (RWJF) Scholar in Health Policy Research (2008-2010) and assistant professor of economics at Stanford University, explains how her new product helps physicians and nurses embrace the future of medicine.

Caring for patients is becoming increasingly complex. A whopping 68 percent of Medicare beneficiaries have multiple chronic conditions and, of those, 54 percent have four or more.

There is no doubt that innovations in information technology are essential to meeting this challenge and improving the quality and effectiveness of health care. New data streams are creating increasingly rich stories of our individual health—chronicling how we eat, sleep, exercise, and even what our genes predict.

New modes of delivering care are arising as new technologies offer more precise, more accessible vehicles to manage our health, including telemedicine, remote monitoring, connected messaging, and smart devices. What’s blatantly missing in these tools of the future, however, is a full understanding of how to connect with the key individuals who deliver care: physicians and nurses.

I gave this problem a great deal of thought during my time as an RWJF scholar. When it comes to our health, we rely heavily on the expertise of physicians to guide our way. The physician is uniquely positioned as the true change agent in the delivery of care.

Yet, physicians and other frontline providers are still seeking trusted point-of-care tools that can help them quickly access and digest key information, make decisions on optimal treatments, and act upon them effectively. Unfortunately, today’s EMRs do the exact opposite.

As context, I’ve experienced EMRs firsthand. Since our teens, my brother Conan and I have helped our father run his family practice—we’ve built furniture, hired staff, assisted patients, and haggled with payers. A few years ago we made an earnest attempt to select an EMR. After dozens of demos with every ambulatory EMR vendor we could find, we were dumbfounded. Besides the horrific expense involved and the eye-popping amounts of training time required for use (the latest Health Affairs study estimated $250,000 in costs and 134 hours of preparation per physician), the most shocking realization was that, even after we crossed those hurdles, the systems would slow our practice down to the point of us needing to either hire additional staff or see fewer patients.

Putting the Provider First

Rather than an invaluable clinical tool to deliver care, many clinicians see EMRs as burdens, not enablers; as distractions from the patient, not facilitators. At best, EMRs are built for billing, compliance, and administrative reporting. They feature dazzling dashboards of checkboxes, dropdown menus, required fields and redundant text, very few of which actually reflect a physician’s clinical train of thought or the information needed for patient care.

Today’s EMRs reflect a fundamental misunderstanding of the essential clinical role these tools should play. The medical record of modern medicine cannot simply be a static repository of documentation for reimbursement or liability protection; it needs, first and foremost, to be a clinical tool,  an indispensable sidekick that helps physicians and nurses tackle the growing complexities of patient care.

In creating ElationEMR, Conan and I took that “clinical first” approach. We believe that the EMR should help rather than hinder care; it should support rather than disrupt the physician’s clinical train of thought; and it should be the smart interface that brings powerful, patient-relevant information to the physician’s fingertips in a way that’s seamless, integrated, and actionable.

Putting a clinical-first EMR in the hands of all physicians is the first step toward tackling the increasingly complex landscape of medicine. As similar tools become embedded in every patient care experience, the resulting data will reflect truly comprehensive stories of patient health and outcomes. The power of that big data to generate new medical knowledge and insights and to individualize optimal care for every one of us will be enormous.