 Instrumentation
for Web-Based Electronic Health Records
(
http://www.nist.gov/ehealth)
Gordon LYON (lyon@nist.gov)
Overview: America needs electronic health records (EHRs)
to address growing medical challenges in chronic disease care, medical
safety, insurance coverage handling and public safety. The EHR trend
is for flexible, open systems based upon the World Wide Web. However,
concern exists about medical staff productivity as the EHR moves
into smaller organizations. Hospitals overcome the EHR system's
input overhead (user keyboard and screen actions) via substantial
automation payoffs within the hospital's complex record processing.
Smaller clinics with simple record keeping cannot do this--they
must reengineer their work and record flows for more efficiency.
Fortunately, an EHR system is very useful for finding and making
clinic flow improvements. This project investigates fundamental
measurement diagnostics for clinic workflow/record-flow improvements
in the context of an open, Web-based EHR service.
Industry Need Addressed: To be truly effective at national
levels, EHR systems must be valued and used by the full spectrum
of medical providers. Although hospitals and larger clinics can
justify EHR investments via overall institutional returns, local
clinics or solo practices typically cannot. Smaller practices, which
constitute a substantial fraction of medical practice in the US
(e.g., 40% is solo), will resist conversion to current EHR systems
if –as is now the case—the EHR imposes productivity penalties that
outweigh gains. A simple EHR automation of current, in-place record
flows of a practice or clinic is unlikely to yield anything near
the full benefits of electronic handling [1][2].
NIST/ITL Approach: Our approach is based upon:
Impact: Record flow and workflow problems are the number
one impediment to EHRs being widely accepted and adopted [3].
There is an opportunity for developing EHR flow/workflow tuning
methods such that smaller medical practices truly benefit from electronic
records. Our ITL instrumentation is thus a first step in creating
genuine market pull for EHR technology throughout the full range
of health care use.
[1]
Principles for Automating Your Practice.” Proc., TEPR 2003, San
Antonio, TX, May 24, 2003.
[2] Waegemann, C. Peter. “EHR vs. CCR.” at: www.medrecinst.com/resources/ccr/index.asp
[3] Mellin, Andrew. “Driving Successful Ambulatory Order Entry and
Order Management Utilizing Intelligent Workflow,” Proc., TEPR 2003,
San Antonio, TX, May 24, 2003.
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