Wish List for an EMR

[Mike]

I would like to put together a list of must haves for an EMR, and we can use this to build a review/FAQ of EMRs, there is no review out there to my knowledge, at least in the recent year, so please, do give suggestions, comments, no sales pitch,

[Mike]

AAFP site (http://www.aafp.org/fpm/20020100/50look.html#box_a) Is a good place to start for the discussion, any other comments?

[Mike]

This is the old review I meant (http://www.aafp.org/fpm/20010100/45elec.html)

[LGrant]

Here is another one (http://www.thecem.net/Downloads/path.pdf) :D

[LGrant]

And this one (http://www.emrupdate.com/downloads/Comparison%20Table.xls)

It is an excel spreadsheet, a bit old, I will try to talk them into updating it

[BigDoc]

Recent one from Physicians Practice (http://www.physicianspractice.com/index.cfm?method=parent&submethod=details&article_id=494&r=p)

[carinc]

Are you looking for general items or are you wanting to gather specifics for the different specialities as well?

[BigDoc]

Maybe a general one for starters

[Scroggie]

Portability between systems (different EMRs)/Platforms would be great.

[Mike]

I think there is an HL7 standard that all EMRs should be able to interface with different hospital systems such as Labs, Radiology. I don't know which ones do so at the moment

[Scroggie]

Mainly expensive ones. HL7 is (from what *they* say) expensive and cumbersome. Why can't things be simple?

[LGrant]

Maybe because a lot of the old lab systems are still using Unix systems

[BigDoc]

A more recent review (http://www.chcf.org/documents/ihealth/ForresterEMRBuyersGuideRevise.pdf)

[Mikey]

There is a difference between portability and interfacing. Can systems interface using the HL7 standard? … yes. Will this make the entire patient chart portable? … no.

In order exchange the entire patient chart you should use a controlled medical vocabulary like Medcin.

[MHDoc]

And what is that?

[Mikey]

MEDCIN is a set of clinical terms supplied ready-to-use. The Intelligent Prompting presentation engine presents a short, relevant list of these MEDCIN terms for rapid documentation.

In order to be clinically usable, terms in a medical terminology must be medically related. MEDCIN's presentation engine provides these medical relationships through multiple clinical hierarchies for each MEDCIN term. For example, chest pain is related to fever in the diagnosis of bacterial endocarditis, but not in the diagnosis of angina. MEDCIN includes millions of these medical relationships.

A terminology must provide a computer program with additional information for each term, other than just the words. Each MEDCIN term has an associated property record containing items such as relevant value ranges, units for tests results, laterality flags, control for narrative presentation, cross-references to external code sets, etc

[BigDoc]

Mikey, there is a web site I found a while back that must be running this Medcin engine, it did just that, and was quite accurate, I wish I could find the URL

[Mikey]

Hey BigDoc,

Medcin is published by a company called Medicomp and the EMRs using it that I know of are:

- EHS (CareRevolution)
- MedcomSoft (Record)
- WebMD (Intergy)
- Allscripts (TouchWords)
- InteGreat (IC ChArt)
- Integrated Healthware (formerly Wang)
- Epic (EpicCare)
- Digichart

Besides these vendors there is also the DoD that uses Medcin for its entire CHCS II project.


Hope this helps


Mikey

[jlively]

Unfortunately, a "controlled medical vocabulary" will not provide portability either. This is only useful to provide standardized vocabulary, between the software using the same "controlled medical vocabulary". The vocabulary produced by Snomed is different from that produced by Medcin. However, this does not mean that users of WebMD can transfer patient charts (as data) to a user of EHS or Allscripts. Portability refers to the ability to electronically move data between dissimilar sytems. HL7 does this to some degree, but it does not contain all elements that an EMR might. An example of portability would be of EDI claim transfers using NSF or ANSI standards. It doesn't matter what Practice Management system I use or what system the insurance carriers use the claims will be recognized by both. (Not that that makes the insurance carriers pay any faster, they still seem to find a way to delay paying :confused: ) Couldn't resist, I had to dig bit at the insurance carriers.

[Mikey]

I have to disagree with what you say ... I was lucky enough to get into HIMSS (even though I was on holiday with my family ... I guess you're a workaholic, or you're not :) ).

Anyway I saw a company called Medcomsoft extract their entire patient chart and import it into Medcin at the Medicomp (the company that makes Medcin) booth. Now to me that would indicate that ANY system that uses Medcin could import that data. The guy at the Medcin booth also told me that they will be mapping to Snomed.

Michael

[jlively]

As an evaluation of the portability of Medcin I just purchsed the Medcin controlled vocabulary tables (the vocabulary table $195 not the SDK $500,000). I received all of the documentation for the tables and the SDK.

Medcin provides a means for portability but the software writer must make their software so. Medcin documentation gives very clear requirements for table structure. If you do not follow their guidelines then you will not be compatable with other systems that use Medcin. Medcin itself does not have the functionality for mapping fields, trasferring data, joining different tables used to create the chart, etc. In other words if you want it to be portable then you must use the Medcin table structure and write a function to import/export into your software. The software that the trasfer is being made to must also have the same table structure and have the exact same import/export functionality. In my opinion, based on this evaluation, Medcin DOES NOT provide portability, only a means if the programmers decide to use it.

It is a great start though and much better than SNOMED in my opinion. The next step would be to make a national standard, such as HL7, that would standardize the transfer of data between all compliant systems. It must have the capability to handle all components of a medical chart though, which is currently lacking.

Mikey, what you saw at HIMSS was the result of the programming of MedcomSoft not Medcin. MedcomSoft has developed the import/export functionality into their software that will allow it to interface with a number of other software packages. I spoke with one of the developers and he stated that this was a unique feature that gives them a selling edge. This is not available in the other software to allow it to pull from MedcomSoft. The MedcomSoft software looks pretty interesting though.

[LGrant]

A more recent review (http://www.chcf.org/documents/ihealth/ForresterEMRBuyersGuideRevise.pdf)


Here is a good list of must have's for those shopping for an EMR (http://www.elmr-electronic-medical-records-emr.com/)

and this also from the same site (http://www.elmr-electronic-medical-records-emr.com/EMR_Requirements.htm)

[EMRhelp.org]

Another good read to help you pick an EMR.

http://www.rheumatology.org/products/coding/03emr_toc.asp

[DrWinn]

Another good read to help you pick an EMR.

http://www.rheumatology.org/products/coding/03emr_toc.asp

Actually, the rheumatologist that headed up the decision process was spoon fed by a consultant, Mark Anderson, whose knowledge of EHR vendors has been proven erroneous on many occasions. A better bet is probably physician reviews by actual users - the AAFP site (http://www.centerforhit.org/x290.xml) has a fairly comprehensive list - although they now require you to be a member to look at the reviews - that's wrong!
I believe EHRs are like cars - there is no perfect EHR; different ones appeal to different specialties/physicians.

[Mikey]

Hi Dr. Winn,


There are only 16 types of people in the world, those that understand hexadecimal, and those that don't.

You might want to brush up on your hex ;)


Michael