Electronic Health Records

Adoption & Implementation News

Specialty physicians driving EHR design, workflows at Cerner

By Kyle Murphy, PhD

For the past several years, specialty physicians have called attention to the deficiencies of EHR systems tailored to primary care, acknowledging that one size does not fit all when it comes to EHR design. The same can likewise be said of EHR design within specialty medicine itself. “As an obstetrician, I’ve just got different things I do than a neurologist, which is different from internal medicine doctor is going to do, which is different than an orthopedist,” Dr. Jeff Wall, OB/GYN and Physician Executive for Cerner, told EHRintelligence.com at HIMSS13.

Depending on their area of practice, specialty physicians prefer certain workflows and functionalities. An orthopedist finds more value in X-rays than other practitioners based on the care he provides, offers Dr. Wall as an example of these nuances. In light of this variation among specialists, specialty EHR systems need to reflect how these providers interact with patients and document their patient encounters.

In his role at Cerner, Dr. Wall has undertaken the challenge of providing a specialty EHR solution that is able to meet the needs of as many as 20 different types of specialists, from cardiology and surgery to neurology and ophthalmology. And he has done so by placing a high value on the input of these very physicians.

“The Physician Experience Initiative started at the beginning of 2012,” explains Dr. Wall. “We’re developing what we call playbooks, and each of those playbooks looks at the way the desktop software — there are 600 decision points that affect physician usage of the software — we look at each one of those decision points as providing the best answer for how the software should be set for that particular type of physician.”

And while specialty physicians share a number of similarities in terms of their workflows, this vetting process highlights the subtleties that distinguish one specialist’s workflow from another. It’s a process that Dr. Wall and his team at Cerner believe will be a trend for the EHR vendor community going forward as physicians come to have a larger say into how a system is designed and customized to fit their clinical needs:

It’s a natural evolution based on the fact that there are a lot of angry docs out there going, “Really, this was designed by engineers. Nobody asked my opinion, and you’re telling me I got to use it.” One thing we’re doing to address that is that we actually have a team of user-interface and usability designers so that whenever we have some new functionality, it actually gets mocked up and goes through extensive rounds of usability testing before the engineers ever write a single line of code. By the time we get to where we’re coding it, we get a design that doctors have signed off on.

Because software design is an ongoing process, Dr. Wall suggests that we can expect from EHR vendors more tools geared toward allowing healthcare organizations and providers to analyze how they are using their systems and identify areas where improvements can be made either through EHR optimization or user training.

With the attention of EHR vendors expanding to now include specialty physicians and non-primary care workflows, the EHR systems themselves must become more adaptable and agile in accommodating the needs of an array of providers. As the experience at Cerner has shown, the solution can be found not in creating wholly-new EHR software but in presenting information to different subsets of users that aligns with their clinical care.

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