Physician-designed EHRs work better for doctors

A primary care doctor spends his or her day collecting and organizing data.

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Before writing and using my own software, I would find myself looking up the same medical information in reference books over and over again.  It turns out that much of the information we look up is information that we use regularly, yet infrequently.

Mark Leeds, DO

When learning to write programs, I began to see my work as a physician in terms of code and problem solving. I began to live by something known in the programming world as the DRY principle.  It stands for "do not repeat yourself".

Taming the long tail

The problem is what they call the "long tail" in the world of search engines.  The majority of things we look up are things which we rarely look up.  For example, the searches we do for prescribing information on drugs we only prescribe a few times per month or year make up the bulk of our searches.

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The long tail of infrequently looked up information is easily stored and recalled.  My goal was to write programs that helped me to avoid performing repetitive activities throughout my day.

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I have optimized my particular software system to allow me to work more efficiently.  My goal is always to minimize repetitive tasks and simplify tasks wherever possible. Clearly these optimizations lead to time savings.

Saving time and effort to prevent burnout

Saving time is important when it comes to documentation. Writing notes about our patient encounters takes time away from the patient. Charting becomes an evening event that takes away from family time.

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In addition to saving time, saving mental effort is just as important. Imagine a patient asks to change a medication back to what he was taking eight months ago. The request may be reasonable, but now the search begins. In a paper chart, we start flipping pages endlessly. In many EHRs, it can be just as difficult. We start to feel like a trained circus act, jumping through hoops.

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It could also be that a patient asked for a referral to a good cardiologist. Who was that great one you sent that other patient to last week? Or, they want to know what study you ordered for them two years ago. Page flipping or clicking through endless pages, tabs and menus can stress out our overworked brains.

I was able to design my system in such a way that I can access data and leverage data efficiently, not only saving time, but also saving mental effort and stress. I consider much of the activity in charting to be orders. Prescribing medication, ordering a blood test, an x-ray, a referral to a specialist, are all different types of orders. I organize them by categories and subcategories. I can easily look up orders for a particular patient or in general for all of my patients. The examples given here are just a few of the places where I reduce the needless heavy lifting that my brain used to do throughout the day.

Finding new ways to get work done faster and smarter

I have also designed my own templating system that ensures that the usually repetitive parts of a note do not look like copy and paste text. My system blends data known about the particular patient with preset data that I choose that also applies to the patient. The intelligent templating system puts it all together into a note that is thorough, yet takes less time and effort to assemble. There is a cost in work up front when I first see a patient, entering the bulk of their medical data for the first time. This cannot be avoided, though in a busy practice, it can be delegated.

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Why not demand fixing the broken system?

I personally cannot imagine working with a scribe. Using EHRs in hospitals has become so difficult and time consuming that there is a new class of worker to operate the EHR for the doctor. Doctors now fight for the right to have scribes assigned to them.

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When doctors can be more involved in designing the system, the EHR will evolve into something that works for them rather than against them. Also, for many doctors, the creative act of designing software and workflow can be an invigorating experience. Human beings generally love to be creative and bring new ideas and inventions into the world.

EHR is the new stethoscope

Today, my EHR is essential to my daily work routine.  It works so well for me because it was not imposed on me.  I am not forced to work within a structure designed by a programming team for a commercial EHR.  My system has evolved with me and always in a direction that makes my work easier.

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Anyone can design their own EHR.  You don't even have to be a programmer to get started.  You just have to have ideas and know what you want.  The building blocks are already there.  There is no need to reinvent the wheel.