By Dr. Donald Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.
A board-certified anesthesiologist, researcher, medical educator, and entrepreneur. With more than 15 years of experience in healthcare, Dr. Voltz has been involved with many facets of medicine. He has performed basic science and clinical research and has experience in the translation of ideas into viable medical systems and devices.
Thanh Tran, CEO of Zoeticx, Inc. also contributed.
Medicine is not often thought of as a creative industry. We focus instead on science and evidence. Behind the science is a group of driven individuals who are focused on problem solving.
The patient’s chart is a collection of information and a record of the thoughts and decisions of those who interact with individual patients. Gone is the day of a literary description of a patient’s ailments, the physician’s thoughts, and evidence to support the diagnosis and treatment plan. The medical record was a place to follow the often winding path of patient care.
Medical documentation records the history of a patient’s illness and the interventions one goes through on the path to healing. It is something us physicians take seriously, not only to meet legal and professional obligations, but also to record our thoughts. The record captures the creative or artful side of medicine.
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By Dr. Donald Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.
A board-certified anesthesiologist, researcher, medical educator, and entrepreneur. With more than 15 years of experience in healthcare, Dr. Voltz has been involved with many facets of medicine. He has performed basic science and clinical research and has experience in the translation of ideas into viable medical systems and devices.
Thanh Tran, CEO of Zoeticx, Inc. also contributed.
Medicine is not often thought of as a creative industry. We focus instead on science and evidence. Behind the science is a group of driven individuals who are focused on problem solving.
The patient’s chart is a collection of information and a record of the thoughts and decisions of those who interact with individual patients. Gone is the day of a literary description of a patient’s ailments, the physician’s thoughts, and evidence to support the diagnosis and treatment plan. The medical record was a place to follow the often winding path of patient care.
Medical documentation records the history of a patient’s illness and the interventions one goes through on the path to healing. It is something us physicians take seriously, not only to meet legal and professional obligations, but also to record our thoughts. The record captures the creative or artful side of medicine.
Granted, we are all practicing within a system of medicine that occurs at the individual level, but has greater impact with others when viewed from a system-level perspective. Individual medical records in the past were neither developed as a tool for population health management nor to allow for the sharing of quality data, something that today’s EMRs have been developed to support and impact care for the masses.
The challenge now becomes how do capture the creative thoughts of medical professionals and yet make use of EMRs.
I enjoy technology and relish using the many technical tools I work with, consciously making decisions on what tools I use. When I struggle with an application, I search for a better way of getting things done. One of my goals in healthcare is to find a way to do the same things when presented with tools and technology that do not fit into my workflow. Uncovering problems and discovering ways to circumvent them are as important in healthcare as in any other business.
Like me, many of my colleagues find their relationship with EMRs to be unproductive and constraining to their management of patients. These complaints are often directed at the EMR's themselves and the forms and restrictions they place on user input and the cumbersome interfaces needed to navigate to the patient’s information. Each EMR system has its own constraints that challenge and frustrate medical providers. We are stymied by having to navigate multiple systems in the reconstruction of patient data into a story that has meaning and allows for decision making in the management of care.
Although EMRs have some ability to be customized, it is neither easy nor welcomed by hospital IT to mess with these complex systems for fear they will break other components. This raises questions about the stability and ultimately the expandability of EMR systems to meet current and future healthcare needs.
When I look at the systems and their interdependent parts, I cannot help but think there must be another way to address these issues. We all speak about interoperability. We think about the development of systems that maintain the integrity of data while allowing medical professionals to use their domain knowledge and requirements for patient care to develop tools.
I see the future of EMR's to be much like the iOS platform and the creation of an App Store-like concept enabling healthcare to solve workflow problems from within. The new 2.0 software platforms with open APIs that enables this sort of development is encouraging. I firmly believe that by opening up development of EMR extensions, tools, interfaces and connectivity will allow for creative people within healthcare to solve many of these problems from the bottom up. These solutions will come from those in the trenches. We will not need to wait for the EMR industry to see our issues and add them to the next software release, a slow and frequently ineffective process that does not incorporate users in the solution.
The development of an API allowing interaction with other EMR's holds the potential to meet many of the goals outlined in the ONC's ten year vision for interoperability (http://healthit.gov/sites/default/files/ONC10yearInteroperabilityConceptPaper.pdf). This vision talks about an interoperability infrastructure; something that extends beyond a single EMR and meets the needs of patients and providers.
The challenge of interoperability is great, but open API’s encourage me to explore the possibilities of impacting healthcare from the inside. Validating the potential of a cross-platform application that integrates with multiple EMR's may just be the trigger to restore hope. It provides physicians with a platform to turn their frustrations with EMR's into productive outlets for improving patient care by creating new experiences and optimizing their workflows.
As an example, I am an anesthesiologist working to prove the concept that physicians can productively address the constraints and limitations with healthcare technology by developing an OR management app to address workflow and patient management issues in the preoperative period. I looking forward to working with others in healthcare to define and develop new solutions to patient management. Overcoming the barriers and limitations of healthcare technology are not insurmountable when you engage and inspire others that solutions are possible.
