Customization - Every Patient is Unique

A study was recently completed by the Archives of Internal Medicine, concerning their findings on the quality and effectiveness of electronic health records (EHR). Their findings not only shocked me but shocked the researchers as well. The study stated that the use of EHR was not associated with any better quality of ambulatory care₁. If the EHR systems cannot improve the quality of the health care system, then what would be the point of chiropractors adopting the software in the first place?

The one separating fact that keeps Future Health's EHR system from inclusion in this study's findings is that Future Health's EHR is completely customizable. No patient's health is ever completely the identical, so why should clinics be stuck with dealing with software that restricts their customizable options. They shouldn't. Customization changes the entirety of the portability and usefulness of EHR software. This research study simply proves that not all EHR are the same, as well as why generic EHR could end up becoming more of a problem than a solution.

To Err Is Human
In the late 90s, the Institute of Medicine (IOM) published a document detailing the iatrogenic death and physician errors titled, "To Err Is Human". It was a realization that sparked controversy across the healthcare profession. The IOM did however pose several solutions as to how to mend this grave problem. One of the suggestions was to implement a widespread adoption of EHR systems in order to improve the quality of medical care.₂ EHR are going to offer a powerful solution when it comes to managing the increasing number of prescriptions and medical interventions for our aging population. The IOM believes in the ability of EHR to reduce medical errors and increase the quality of health care.

Summation of the Study
According to the July study in the Archives of Internal Medicine, it can't be assumed that an adoption of the EHR system in medical institutions will actually improve quality of care1. The study's quality indicators were based on the physician's decision to prescribe drugs or antibiotics, order a routine medical exam and preventative counseling. Institutions using EHR only increased their quality on two of 17 quality indicators. These findings greatly surprised the authors, especially when compared with other studies that looked at four benchmark EHR institutions, which indicated increases in care quality.

Knowing the Difference between Effective and Ineffective EHR
What I gained from this study was that all EHR systems are not created equal.  I have found from my own research in developing and creating EHR systems, that comparing EHR systems to each other are like comparing apples and tomatoes. While the similarities might be slightly similar, both are in fact fruits and red, a simple bite into either of them and you'll immediately taste the true difference. The same is true of this study. Health care providers are discovering the true difference between EHR software.

The reality of this tends to lend itself towards discovering inconclusive findings when it comes to evaluating true EHR systems. EHR technology is too new and too diverse for anyone to try and lump them into the one neat category. Only the most advanced EHR systems are truly defined by their ability to organize, integrate and evaluate the clinical decision-making process. The solution, when comparing practices with different types of EHR software, is too examines each software's customization.

What's the Big Deal about Customization?
The study did show the greatest improvements in clinics which had designed their own EHR systems. This goes to show that these individuals created an EHR system that would lend to be completely customized to how their clinic functions. Thus they were able to utilize their EHR system to its fullest potential. They molded EHR documentation process to their own clinical workflow.

No two doctors utilize the same methods of treating a patient; therefore none of them should be forced within the confining regiment of a standardized, non-customizable EHR system. This confinement can actually end up doing more harm than good. It creates an artificial standardization that is unrealistic and may not allow for the recognition of soft clinical clues, or ways to back out of rabbit trails that are created by complicated clinical presentations.  Let's take a look at an example:

We all learned in school that orthopedic exams were objective, standardized tests that created a reproducible clinical picture anyone reading our notes should understand. If we had a disc involvement, we'd see a positive SLR. It was as simple as that. Then we had our first patients in practice and found out that simplicity wasn't always involved. We learn that a positive SLR, from a documentation standpoint, actually reveals almost nothing. In order to make the test noteworthy, it became necessary to document the kind of pain and the angle of the leg with respect to the horizon (30, 45 or 90 degrees), some of which didn't necessarily indicate a disc problem. But you need to document what you think it does indicate, based on evidence, and if the test needed to be modified for some reason or another, based on the patient's antalgic position. A positive SLR became more than just a checkbox we marked on a sheet of paper; it was synthesis of several major clues to the patient's disability. However, your exam sheet doesn't allow you to document all of this, and most EHR systems don't document it either, but Future Health's EHR system is not like most EHR systems.

This is how most EHR systems treat their doctors, like students, instead of the well educated professionals they are. A simple check box isn't comparable to the documentation of a physician's thought process. Most EHR systems have a set list of tests to perform. There is no jumping from exam to exam based on the doctor's preferences and experience in these areas. No, instead physicians are confined into a never-ending pathway of tests, from which it is impossible to find any alternative routes.

We need to utilize the technology of Future Health in order to use technology that allows us to adapt the software to our own internal logical thinking. You can see how this customization would be a powerful benchmark to determining the functionality and therefore, the clinical helpfulness of an EHR system. If EHR are going to increase the quality of health care, they will require customization that empowers the provider.

EHR is Still the Solution to a Clinic of the Future
While medical practices still don't yet have an economic incentive for proving the quality of their care, chiropractors have all the economic incentive in the world to prove that what we do is effective.  Due to this pressure to prove and improve our quality of care, we have become far more atone to EHR and their quality, than the average MD in private practice. By being able to determine the differences between apples and tomatoes we can ensure we will be able to adopt the sweetest EHR for your clinic. Choose Future Health. You'll not only sleep better by improving your documentation and quality of care, but you'll also elevate our profession.

References
1. Linder JA, MA J, Bates DW, et al. Electronic health record use and the quality of ambulatory care in the United States. Arch Intern Med, 2007;167:1400-5.

2. Preventing Medication Errors: Quality Chasm Series (prepublication copy), 2007. Board on Health Care Services, National Institute of Medicine. Available at http://darwin.nap.edu/books/0309101476/html/131.html. Accessed on Aug. 25, 2006.