Clinicians Need to Redesign Their Clinical Practices to Further Stimulate the Adoption of Electronic Health Records

| August 14, 2008

From The Medscape Journal of Medicine

Webcast Video Editorials

Posted 06/02/2008 Peter Yellowlees, MD

A recent editorial suggested that "clinicians must reinvent the medical record in order to stimulate the adoption of electronic medical records."[1] With this aim in mind, and to take advantage of today’s multimedia technologies, I believe it is also time to substantially redesign many of the traditional processes we use to practice medicine.

As we do this we need to follow 2 core principles. The first is the complementarity principle: Computers do well what humans do badly, and vice versa.[2] The second principle is the importance of redesigning business processes before building new software environments[3] — that one should not design new software to support an old, inefficient business process.

We need to think differently, for example, about the doctor-patient consultation. This can be described as consisting of 3 information processes: data capture (history and examination), data analysis (diagnosis), and business planning (treatment). Using the principles mentioned previously, we can now start to identify which components are best undertaken by the various humans involved and which are best undertaken automatically or in a technology-driven manner.

At UC Davis we are testing the notion of store-and-forward cross-language telepsychiatry consultations.[4] Rural primary care providers upload psychiatric clinical datasets and short patient video clips in English or Spanish to our secure Web site. These datasets are examined by English- or Spanish-speaking psychiatrists who create and upload diagnostic assessments and treatment plans, translated as required. Their opinions are then instantly available for primary care providers in the language of their choice.

I encourage all clinicians to think of ways of redesigning their practice processes to make better use of available multimedia technologies and further stimulate the adoption of electronic medical records.

That’s my opinion. I’m Dr. Peter Yellowlees at the University of California – Davis.


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Readers are encouraged to respond to the author at peter.yellowlees@ucdmc.ucdavis.edu or to George Lundberg, MD, Editor in Chief of The Medscape Journal of Medicine, for the editor’s eyes only or for possible publication as an actual Letter in the Medscape Journal via email: glundberg@medscape.net

Reader Comments on: Clinicians Need to Redesign Their Clinical Practices to Further Stimulate the Adoption of Electronic Health Records
See reader comments on this article and provide your own.

Readers are encouraged to respond to the author at peter.yellowlees@ucdmc.ucdavis.edu or to George Lundberg, MD, Editor in Chief of The Medscape Journal of Medicine, for the editor’s eyes only or for possible publication as an actual Letter in the Medscape Journal via email: glundberg@medscape.net

References:

  1. Lesselroth B. Webcast Video Editorial: Clinicians must reinvent the medical record to stimulate the adoption of electronic medical records. Medscape J Med. 2008;10(2):45. Available at: http:www.medscape.com/viewarticle/570116 Accessed March 20, 2008.
  2. Sandom C, Harvey RS. Human Factors for Engineers. Institution of Electrical Engineers; 2004.
  3. Kenneth S. Ledeen, Build v. buy. A decision paradigm for information technology applications. Available at: http://nevo.com/our-knowledge/whitepapers.asp Accessed March 20, 2008.
  4. Yellowlees P, Hilty D, Odor A. Cross-cultural store and forward telepsychiatry, Available at: http://www.ucdmc.ucdavis.edu/psychiatry/research/technology.html Accessed March 20, 2008.

Peter Yellowlees, MD, Professor of Psychiatry; Director, Academic Information Systems, UC Davis Health System, Sacramento, California
Author’s email: peter.yellowlees@ucdmc.ucdavis.edu

Disclosure: Peter Yellowlees, MD, has disclosed no relevant financial relationships in addition to his employment.

Category: Electronic Medical Records

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