Meet The GMR, An EMR That Doesn’t Suck
Doctors, nurses, med students, patients, we should be embarrassed.
Welcome 2007. You can email, send instant messages, order airline tickets in seconds, track that airplane as it flies across the globe, manage your calendar, work on documents and spreadsheets in real time with your friends and colleagues, even read newspapers from around the freaking globe. But our computerized medical records (or whatever you want to call them) can’t even print out labs in the right order. This is, in a word, ridonkulous. Hospitals and clinics should demand more. The big medical record makers should provide more. Their interfaces, truly, look like they’re from 1990.
I have spent a little over a year in hospitals, working as an upcoming doctor, and I’ve seen 8 completely different electronic medical records. (This is working at only 4 different hospitals.) Some are better than others, some are definitely worse than others. The government’s own Veterans’ Hospital’s CPRS software is probably the best, and honestly leaves much to be desired. (This is what it looks like.)
Over the year I’ve tried to collect ideas about the best features (and worst) of these different systems, and I’ve put them all together in something I call (for lack of better): the GMR (Grahamazon Medical Record). It’s an interface only–doesn’t actually save patient data (yet!)–but sadly, I think it’s lightyears ahead of what I’ve seen (and I live in Silicon Valley). It’s mainly a proof of concept–that this could be done, and can be done. (Note: It works in all modern browsers: IE7, Firefox, Safari.)
I’ve put together a screencast that walks you through some of the features. Watch it, and then play around with the interface. My goals, basically:
- Make the software work for you, not the other way around. I see many of my attendings bewildered when trying to figure out basic tasks on current systems.
- Make it make sense. Chemistry panels should come out in the right order. Information should be easy to find and accessible. Information that needs to be known quickly in an emergency should be easily displayed.
- Don’t act like a medical record. Act like a one-stop shop for getting hospital work done. Be context sensitive. Don’t make me call the operator to find out who’s on call. If a lab isn’t being processed, show me who to call for that lab.
- Be legible, and easy to process. I see too many people having to squint and strain to read their monitor.
Note: This is obviously not optimized code for efficiency, it’s my hacking-so-it-works Web 2.0 interface. It could definitely be improved, but it’s a start.
Feedback, as always, is appreciated. (Oh–forgot to mention in the video–you can easily access any of the tabs by doing “Ctrl+letter” on a Mac or “Alt+Letter” on a PC, using the underlined letter.)
(Special thanks to Maria and Nick for their feedback!)
While your interface is crude, it does show promise. (And frankly, I like whenever *anyone* tries their hand at EMR systems.)
What I don’t really see is any modularity, however. That is, the ability (or forethought, in this case) to be able to add additional functionality down the road. While your system seems effective enough for in-house medical records, what about sharing? Sending prescriptions from the hospital to a pharmacy?
I’ve seen some of the more advanced EMR systems in action, and many of them are quite good: formulary checking, advance data search and retrieval, etc. They are not, however, web-based, which makes yours interesting.
If you choose to continue to develop a functioning system, methinks you will grow to hate HIPAA even more than you probably do already. ;)
Absolutely, RJS–it’s definitely just an intro and a start. I love the idea of sharing and some sort of easy database that could find pharmacies and such to integrate into the system.
I like web-based systems because they don’t require any sort of special client, just a modern browser. I’d love to see some of the more advanced, good user-interface systems you’ve seen!
Call me when you want to build and market your EHR system. I have been working for 5+ years on both Medical/Therapy EHR systems.
Good Luck,
Jim Douglas
It’s certainly a worthy goal. My quite large clinic has converted all of its outpatient records (>150K) to electronic. When a patient shows up for a consultation, there’s no more thrash trying to find the chart. Lab work is instantly available; xrays, too, as they are digitized. And there are modules at the hospital, so the doc seeing the patient in the ER or the wards has full access to the records as well. It’s phenomenally good.
Hi,
I really like your GMR interface. It’s pretty user-friendly. I even like your idea about coming up with a central interface that encompasses all the needs / menu items of an EMR (An EMR that should work for you).
Agreed that this is a just a start (A good one though); you might want to consider applying “Section 508″ – Disability compliance measures on the Web Application Development that you have initiated. In the 7 years of IT experience I have seen that the most important that the end-user sees is the User Interface and how easily the information is Accessable.
Just my $0.02.
Regards,
Nainil Chheda.
Great comment, Nainil–I would absolutely run the interface through text-browsers and 508 compliance bots if it actually went anywhere.
I enjoyed your interface. If you are really interested in making “your” EHR, you should consider working with an open source EHR. I work with MirrorMed, but there are others. It would probably take me a few days to make the interface changes that you are recommending. It would probably take you much longer, since you would be cold on the code, but once you had finished you would have a working version of what you want.
BTW, CPRS is only a gateway to VistA which has tremendous depth beyond that. VistA is becoming more and more an open source project. Take a look at WorldVistA.
As far as criticisms, the problem is that your workflows are not everyone’s workflows. Your needs are not everyone’s needs. Making it good for you makes it bad for others. If you want to take this the whole way you need to start thinking like a general (strategically and from the top), currently you are thinking like a captain (tactically, and from your important, but limited, viewpoint).
In any case if you are serious about making a real difference free and open source software is the only place where your ideas can really make an impact.
-FT
We are on the same page.
Nice clean interface.
Patient record centric.
Well though-out.
Clearly where we need to be.
We are working on a similar approach
There is much need for innovation.
I would love to talk with you.
CPRS has some good UI traits but as you said it leaves much to be desired. Many of the software packages grew from one user segment’s viewpoint (nurses, specialty or domain physician, therapists). When this occurs, many basic flows, views and data structures are tailored and another type of user (or better yet – type of organization) will find the application less friendly. CPRS has many features tailored for VA protocols which are not always followed in other environments. The VistA application is feature rich but very difficult to install and setup (I tried it and evaluated one of the earlier versions of WorldVistA).
Sadly, optimizing the work efficiency of medical students and residents is typically a low priority of hospitals, and hence of system vendors. This is at least partly because the marginal labor cost of an extra hour of your time is below zero; that is, not only does it not cost the hospital to have in you in-house for an additional hour, it actually benefits them. Even where that does not apply (e.g. private attendings at a community hospital), optimizing clinician work efficiency is a goal that competes with many others among the hospital administrators writing the checks and the hospital IT staff implementing the system.
Going beyond that, the other commentors are right: optimizing your work means de-optimizing someone else’s. The pressure on vendors is to produce the solution they can sell to the most hospitals, not the one that fits your hospital best. Despite what hospitals think (“we’re all the same, right?”), there is great variation both between and within hospitals, so vendors must often find the lowest common denominator.
Another big issue is the inability of computers to reliably and safely summarize information to the degree that your design presupposes. It comes naturally to us clinicians, so we forget how hard it is. Even supposedly simple subjects become complicated quite quickly, e.g. is smoking a “pulmonary” issue or a “psychiatry” issue, or both? what’s the “dose” of a prednisone taper? And most hospitals would not tolerate a computer’s attempt at summarization because they would (rightfully) not trust it, e.g. describing one of the patient’s meds as “Glipizide 20″ would never be considered safe, even though you and I know that’s how us doctors really talk to each other.
I was like you once: a young doctor who thought the only barrier between me and the perfect EMR was a lack of knowledgable designers and of will. It’s no different than dreaming up the “perfect” car or cellphone and then wondering why it’s not real. In the real world, just changing the number of cup holders in the car is a major decision needing a focus group, a business case, an internal political battle. Now I work in the industry, designing systems in use by doctors and nurses on three continents, and I can tell you that there are many more competing forces than you imagine, and it’s actually much harder than it looks. Still, seeing something you designed in use across an entire hospital system (and more) is very gratifying. I still enjoy the work, but I know that most improvements I work on will be incremental.
If you’d like some thoughts on a career doing exactly this kind of work, feel free to contact me.
Fantastic! If only we had this to look forward to next year. Instead, we have typewriters. So Not Cool.