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Getting Closer To The Ideal Electronic Medical Record

Posted Nov 07 2010 6:04am 1 Comment

Stanley Feld M.D.,FACP,MACE

Over 70 % of physicians use smartphones. Physicians are not resistant to learning how to use an iPhone or one of the Android smartphones. The network speed is the irritation. Networks are confusing the public with 3G and 4 G network speed. They should just do it!

We are rapidly approaching the time when a smartphone will be an appliance. The best applications will survive. Medical applications will become fully functional.

Most individual physicians and group practices have had at least one electronic medical record (EMR). None has fulfilled its promises. None has been fully functional. The price paid for the EMR was high in the era of decreasing reimbursement.

Most practices need a fully functioning EMR. The practices are hesitant to endure the pain of conversion once more.

President Obama’s multi-billion dollar subsidy program is bogus. The amount of the subsidy is well below the cost of the EMR and its continuing service and upgrades. I believe the program will have little impact on adoption of EMRs.

If President Obama provided the ideal electronic medical record along with upgrades and service to physicians for a monthly fee, physicians could afford to sign up. They would not worry about an unaffordable capital expense. Physicians would be charged by the click just as MasterCard charges by the usage.

Instantaneously, the system proposed, would result in America’s physicians converting to a government certified fully functional EMR at minimal cost or risk.

Patients’ data could be kept on a hard drive in the physicians’ office to maintain patient privacy. Physicians would have to agree to release certain data to be used for educational purposes without compromising patients’ privacy.

Instead, President Obama’s new agencies are going to use inaccurate claims data to judge physicians’ care and impose penalties on physicians.

With the increasing development of cloud computing, President Obama could provide the software in the cloud with servicing and upgrading. It would cost the government less and the government would have created an income generating business.

Electronic medical records software producer ClearPractice has developed a SAAS (software-as-a-service application) for the Apple iPad to help doctors manage their workflow, from scheduling to prescribing to billing.

A fully functioning EMR can be developed with physicians using the functionality of an iPad and upcoming Android tablets.

I have not had the opportunity to study ClearPractice’s product. ClearPractice has the right idea. Its Nimble EMR cloud product is the first comprehensive EMR application designed to run on the iPad.

I think its distribution and storage model needs refining. It also should build iPad applications to interface seamlessly with an Android system Pad.

The software can be accessed from the cloud. Patient data files can be accessed from the physicians server using a Pogoplug . This would permit physicians to be in control of their patients’ data.

“In designing Nimble, ClearPractice tackled the slow implementation of EMR software, which costs physicians time and money and disrupts their workflow. "Traditional EMR systems slow down busy doctors."

A tablet can easily keep physicians connected to their patients’ data in their office, in the hospital and at night in their home.

ClearPractice claims its software-as-a-service application has scheduling, tracking in-patient rounds, prescribing, lab review/ordering and messaging applications. It also connects to the physicians’ billing system to automatically capture and submit charges for payment.

Nimble does not sound fully functional. The software must have the ability to connect financial outcomes with clinical outcomes to be appealing to physicians. Physicians must be able to use the data they generate to augment their value to the patient. They are hesitant to submit data to a third party that will use it to devalue their worth.

ClearPractice’s fee schedule is vague. Nonetheless, ClearPractice is on the right track. President Obama could save his subsidy money if he would start listening to physicians. He is going to ahead and will waste the money from the stimulus package. He will not make progress toward the goal of developing universal use of fully functioning electronic medical records.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

Comments (1)
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It seems to me that the SaaS model where physicians can access the EMR from mobile devices would lead to a larger risk of programming and electronic errors, which might prompt the FDA to regulate EMR.  This would be disastrous for many smaller companies in this new-ish industry.  (see http://www.mttlrblog.org/2010/10/30/)
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