Fundamental Issues for Clinicians

Good points Raymond. I agree with your sentiment about the potential streamlining coding, especially in this new era of AI where suggested SNOMED codes could appear automatically in a similar manner to how gmail can finish our sentences now. Even simpler direct searches could work a lot better. The main issue is the lack of a business case to prioritize this development over more pressing matters for the EMR vendors, such as implementing new system integrations to simply keeping the lights on. I think it will require the next generation of EMRs to leapfrog the current UIs and hopefully nail these foundational UX concepts as part of their core design. Unfortunately EMR generations are longer than human ones.

Hello,

I am an IMG living in Victoria, BC and currently doing research on Problem Lists (PL). My research focus has shown that there are multiple areas for improvement in terms of usage, ownership (who maintains an active daily PL), and quality issues (like incomplete PLs etc.). Hopefully, some of this research may become meaningful and helpful for practising physicians.

Sincerely,

Rajesh Nair

Are there any physicians who are interested in posting thoughts on the Problem List and/or the patient summary?

These are hot topics and are going to impact what physicians do in a lot with regard to the time and effort to maintain these things. If these are well designed they will be tremendously useful when it comes to managing patients.

Many EMR users are not happy with the programs they are using. A few will take the time to complain to their vendors. Vendors get confused when different users ask for diametrically opposite features. In many cases that I know of the problem is based on not understanding what the fundamental problem is. There is a typical disdain for coding a diagnosis and users ask for either free text or as few codes as possible. The root problem is that they are trying to use ICD-9 which is obsolete and not fit for purpose. Users trying to find a diagnosis are stymied by the obtuse descriptions in ICD-9 and the lack of clinically relevant items. This is compounded by EMRs that have poorly designed search algorithms. If an appropriate reference list is used with a good search algorithm finding a desired diagnosis can be quick and easy.

The other problem is the inconsistency in the information models used by different EMRs which nullifies the ability to exchange computable data.

There is a lot of uninformed opinionating and this combined with institutional intransigence has resulted in solutions that were identified over 10 years ago are still not implemented. Sorry to sound negative but it is sad that things are taking so long to get to where we might have high performance applications on our desktops.