Thursday, 5 May 2016

From More Paper to More Checkboxes, Whats Ideal in Health IT?



Was in a tweetchat sometime ago on the Need for Time Management for Practitioners (physicians, nurses, allied health professionals) in Healthcare, by the HealthXPh communities Weekly Tweetchat, Every Saturday.

During the conversation it was really interesting to hear from the practicing doctors regarding how they have to manage their time and work towards scheduling themselves around their HealthIT systems and their patient care activities.

It was really interesting because, aren't the Healthcare IT solutions supposed to ease the workload of the users? Arent the solutions supposed to be developed around providing the Time Management activities of the healthcare practitioner?


Which again brings me back to my earlier question, arent the Healthcare IT solutions help the Healthcare Practitioner Manage their time? After all we have taken the paper records and replaced them with the feature rich and innovative healthcare IT solutions.

But then why do we hear the doctors say that they are losing direct face time with the patients?

Why are the nurses unable to find time to keep up with the IT and non-IT related work they are supposed to be doing daily?

In the multiple product development lifecycles that I have been through (and the experience of the reader might be the same or vary) I have found during the requirements phase there are two types of users, the first category are the ones who have perhaps not used a system earlier but would like to implement a healthcare solution. The second category are the ones who have had prior experience working on a solution and would provide their requirements that incorporates the enhancements or the lacunae that the earlier solution had.

I think the EHR systems are in this conundrum right now, wherein they need to fit into these two categories of users and fast. Building products is a capital intensive enterprise and the 'project management' practices are always focussed on gathering requirements and completing the project.

But during this 'Delivery' process are the requirements of the two categories of users been analysed in a way to deliver solutions that will take into account the needs of the users and come up with a solution paradigm that helps each of these users to 'Manage' their time.

Should the solution make a Healthcare Professional work their way around the solution, or should it be the other way.

I think it is this need for the solution to now work around every Healthcare Professional to help them manage their time better that will bring about the version 3.0 of the EHR solutioning.

In the version 3.0 of EHR solutioning multi-disciplinary teams will come together to develop the solutions that work around each users life-at-work and helps them to Manage their tasks in their workplaces.

As indicated in the recently concluded ArabHealth a message went out indicating that "One size does not fit all"

Tweet: 





Extending the analogy to an EHR solution: If there is a uniqueness in treating each patient, it is obvious that the activities that a Doctor or a healthcare professional would do would be unique. At this point I do agree, that the process would perhaps stay same for the 80% of the time, but the datapoints to be presented or captured would perhaps be different from patient to patient. 

I therefore think that the next generation of EHRs should be able to incorporate these variations as part of workflows that allows the solutions to be adoptive to the end-user requirements across specialities. 

Some feature considerations for the next gen EHRs. 

  1. Incorporate Task and Workflow oriented frameworks. The workflow in the hospital is not stationary, it evolves as often as a patient's condition
  2. Incorporate the Healthcare Practitioner's daily activities in the workflow, help them manage their time a, and not they working around what the system has to offer. 
  3. OK, so we converted all the paper forms into electronic formats and now have the ability to analyse them. Its now time to bring in cognitive platforms that present to a doctor generated pages that are relevant to a patient. 80% of the forms are not filled in 80% of the patient visits. Then why should all this data be 'presented' to be filled for each patient?
  4. At the design time consider the time and motion analysis for each category of user, develop solutions to incorporate their activities. 
  5. EHRs should adopt a multi-form factor delivery approach. Now its clear, the desktops and PCs are here to stay. Go back to the drawing board and develop 'for-each' form-factor. A one size fits all or a responsive approach perhaps will not work in the case of the healthcare multi-form factor solutions approach. After all you cannot expect a 5 page form to be answered on a mobile device, just because we can make it responsive. 
  6. Make EHRs with the analytics first approach. Since the first systems, its always been the need to capture the infomation on systems so that we can analyse the data later. Today there should be the need to revise the data structures to meet the demands of analytic and cognitive computing.
Am sure there are more that can be collated, but will keep that for the Zen Clinicals series that I have been working on to define what a next generation EHR should have as core feature set and that is different from what it is today. 


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