Thursday, April 5, 2012

EMR User Interfaces: Embedding Team-Based Care and Knowledge

There's a great new article in the March 2012 issue of The American Journal for Managed Care, "IT-Enabled Systems Engineering Approach to Monitoring and Reducing ADEs".  You can find it here.  The point I'm trying to make in this blog, by drawing attention to this article, is this:   It's time for EMR vendors to rethink the fundamental design and user interface of of their products.  They've been basically unchanged for 10 years, at least, supporting the same concept of encounter-based care that itself goes back at least 50 years.  EMR vendors need to stop thinking of patient care as short term encounters with a clinician and start thinking of patient care as long term project management with a team of care providers.  EMRs user interfaces need to look more like a project management tool that enables social collaboration, task assignment and follow-up, and the collective wisdom of the care team, including the patient's wisdom, more effectively.

In summary, the AJMC article concludes that, by using web-enable team resource management (TRM) tools, clinical work teams can significantly reduce the rate of adverse drug events in patient care.  According to the article, "the rate of ADEs decreased from 25.8 to 18.3 per 100 patients per year in the intervention group. The rate was virtually unchanged in the control group (24.3 vs 24.8)."  That's a major impact.

The study described in the article is particularly impressive in that, the TRM tool leveraged the collective wisdom of the care team in identifying, tracking, and measuring the causes and interventions associated with ADEs.  It's a prospective model for preventing ADEs versus a retrospective root cause and failure modes analysis of what caused the ADE.  Very, very impressive approach.  The team at  the Department of Family Medicine and UB School of Management, State University of New York, should be widely acknowledged for this innovative yet common-sense approach to patient care.

EMR vendors, please take note.  :-)

1 comment:

Chuck Webster MD MSIE MSIS said...

With respect to your:

"It's time for EMR vendors to rethink the fundamental design and user interface of their products....EMRs' user interfaces need to look more like a project management tool that enables social collaboration, task assignment and follow-up, and the collective wisdom of the care team, including the patient's wisdom, more effectively"

I agree!

Sounds like you are describing clinical groupware. Here's one definition:

“Intentional care team processes and procedures pertaining to the observation and treatment of patients plus the tools designed to support and facilitate a care team’s work.”

http://chuckwebster.com/2010/02/ehr-workflow/clinical-groupware-a-definition

Clinical groupware is based on a combination of business process management (workflow engines executing user-defined process definitions)...

http://chuckwebster.com/2010/05/ehr-workflow/emrs-ehrs-and-clinical-groupware-need-to-solve-the-bpm-problem-why-not-use-bpm-to-help-do-so

...and adaptive case management (user control over process definition execution at run-time, including ad-hoc intervention)...

http://chuckwebster.com/2010/04/ehr-workflow/tweeting-live-from-processgov-the-bpm-in-government-event-april-14-15-2010-reston-va-looking-for-the-healthcare-angle

...technology.

Many BPM and case management systems include mobile and social media functionality. During design EHR BPM systems can include patients in the care team by creating patient* roles in (what academics call) "process-aware" healthcare information systems.

(*or customer or client or whatever you wish to call the intended beneficiary of trillions of US dollars)

I've been tracking this technology for over a decade and, until recently, I was as frustrated as you at the lack of progress.

Fortunately I'm seeing a lot of light bulbs going on over a lot of heads in both traditional health IT and the BPM and case management IT industries. The former is thinking (something like): I have all these process problems, traditional health IT doesn't seem to be capable of solving them, in fact sometimes it makes them worse, what are alternatives?) The latter is thinking (something like): I've got this great process-oriented technology, I've successfully applied it in lots of industries, I'm reading and hearing that healthcare has lots of process problems, let's use BPM and related technologies to solve healthcare's process problems!

Here's an example of such a conversation between health IT and BPM professionals:

http://successfulworkplace.com/2012/03/16/translating-healthcares-rosetta-stone/#comment-1019

Great post based on great insight. I suspect it is resonating with a lot of people.

Best

--Chuck

The Death of Risk, Adventure, and Accountability in Our Lives

This article , entitled, "23 Dangerous Things You Should Let Your Kids Do", prompted me to pause and think. Here are the 23 things...