Remember your last trip to the dentist. The reclined, squeaky-leather chair, the beaming glow of the overhead light, the little swiveling sink off to the side, the dentist or dental hygienist rummaging through their small tray of various instruments; the angled mirror, periodontal probe, and, if you were really unfortunate, the dreaded drill. Now, take a moment to recall your last visit to your general practitioner. You most likely sat in a relatively bare room- save for a paper-lined, flat bed, a stethoscope, and perhaps a sphygmomanometer. It isn’t difficult to see why the two offices look so unique- different fields require different tools of the trade. What works for one, will not necessarily work for the other.
Obviously, every field of medicine is unique. The procedures, frequency of visits, implementation of care, amongst other things, all represent variables that affect how different practices are run. It should follow then that EMR systems have different functionalities and features to address these core differences. The current one-size-fits-all approach to EMR systems fails to recognize and appreciate how these differences can affect their meaningful use and effectiveness in the workplace.
Obstetrics and gynecology represent one field that requires individual EMR system functionality in order to effectively manage patient data. OB/GYNs are unique in that they are both a medical and surgical specialty, they are hospital and office-based, and they require different data and image displays than other medical or surgical disciplines. Practitioners of obstetrics and gynecology are currently feeling pressured to adopt systems that don’t address their needs in a meaningful way, and as a result are reluctant to make the switch.
Antenatal care helps to illustrate some of the key issues where EMR systems’ features fall short for obstetricians. First, the frequency of visits represents a factor that differs from many other disciplines. The data from these visits could be best utilized if presented in a flow-chart layout, as opposed to individual files for each visit. This would save time and help to track patient progress in a comprehensive way. Currently, there are few EMR systems that incorporate data in this way, severely limiting OB’s choices when it comes to choosing a system.
Additionally, during antenatal care, the obstetrician must monitor both maternal and fetal trends. This is an attribute that is unique to obstetrics and one that requires an individualized solution in EMR systems. This data is both exclusive to the respective patient (mother or fetus) and interconnected between patients as the trends of one has implications for the other. In order to effectively monitor and address these trends, they need to be integrated in whatever EMR system is being used by the obstetrician.
Finally, images and reports such as ultrasounds and non-stress tests need to be readily and remotely accessible, interactive, and incorporated into the flow-chart design to monitor changes and trends.
Not only do EMR systems have to integrate specific features in order to operate meaningfully and effectively for obstetricians, they must also have interoperability between office and hospital settings. Currently, most doctors, even those with EMR systems in place, are required to fax, mail, or hand deliver records to the delivery unit of their hospital. This seems to defeat a principle purpose of the systems; the ease of exchange of information.
While gynecology does not present as many specialty-specific EMR system requirements as does obstetrics, its EMR system needs should not be overlooked. One of the primary tools of any gynecological practice is the use of imaging. Still images and video should be incorporated into a patient’s file so that it is easily accessible and annotatable. As with obstetrics, a flow-chart design would make the tracking and monitoring of new developments more efficient and help to integrate all of a patient’s data in a meaningful way.
Many gynecological diagnostic procedures, such as hysterocopies, utilize video imaging. Gynecologists would benefit from an EMR system that contained the capability to capture still-images, add annotations, and incorporate this data into the patient’s chart in a way that saves time and enhances the overall comprehensiveness of each office visit. By compiling patient data in a flow-chart with linkable images and the ability to flag certain data it would facilitate a more comprehensive approach to patient care and decrease the amount of time spent by physicians sorting through numerous files. And, after all, isn’t improving the quality of care while reducing extraneous waste of resources what EMR systems are all about?
EMR system design is still in its budding stages. As with any new technology it is the basic infrastructure that must come first, setting the foundation for each successive level to come. Upon the concrete slabs and rebar of today’s EMR systems will one day be built the intricate and robust systems that will wildly exceed even our current expectations.
The preceding is but a sample of some of the specialty-specific requirements for EMR systems for OB/GYNs. Few, if any, current EMR systems contain a comprehensive set of features and functionalities optimal for effective, meaningful use in obstetrics and gynecology. As the demand for more robust systems increases, so too do their capabilities. However, progress does not happen in isolation. It is marked by those who inquire, who gather information, and who call for change. The best way to realize the changes you would like to see in EMR systems is to be an advocate. Talk to other doctors, to EMR system providers, to office managers, and to hospital directors and voice your opinion. Do not sit idly by and let someone else design a system that will be as integral to your profession as paper charts once were. Remember, this is your profession and these are your patients. Be an advocate for them and for yourself and help pave the way for the EMR systems of tomorrow.