My EHR Wish List

September 23, 2014

This primary-care physician wonders why Google knows her preferences, while her EHR doesn't have a clue.

I've come across a number of articles recently that decry the EHR's impact on physician happiness and satisfaction. While there are only a few physicians out there who still contend the superiority (in terms of completeness, safety, and connectedness) of the paper chart to the EHR, most physicians concede the necessity of EHR, with only a few grumbles and complaints.

I am in the category that a change theorist would call an "early-adopter," so I am generally a fan of technology and use it readily. However, I still wonder why my EHR cannot do what my bank, library, and hair salon do virtually, and why Google and Amazon both surpass the EHR in terms of connectedness, ease of use, and all-around technological goodness.

For any EHR technologists or engineers out there, here is my list of wants and must-haves, as an "in-the-trenches" practicing physician.

1. Help me recognize my patients. I cannot easily remember the names and faces of thousands of patients. I forget who they are married to, what they do for a living, and even our last conversation. It would be great if the EHR featured the same type of technology that allows those pop-ups when I am on my computer that are personalized to the last thing I was shopping for online.

2. Allow me to communicate better with pharmacies. I have no way to "cancel" or "discontinue" a medication through the pharmacy other than picking up the phone and calling. This leads to medication errors and confusion all around. If TripIt, my travel app, can search my e-mail inbox and remind me of the details of an upcoming trip, why can't the EHR sync with the pharmacies and adjust the medication list in real-time.

3. Reduce the need for my wet signature. If money can be moved electronically in vast sums with reasonable security, why can't I electronically prescribe controlled substances? Surely it is easier to forge a paper prescription than an electronically generated secure fax.

4. Allow for more than just plug and click technology for online scheduling of appointments. At my salon, I can choose from several dozen different services online - from facials to massages - with a dozen different therapists and aestheticians, and get the correct appointment for the correct "procedure" reliably. Plus, I get a text message alerting me to the appointment!

5. Integrate more smart-software that supports my clinical decision making. My EHR has perfected the warnings that indicate a potential interaction if I prescribe an antibiotic to a patient with blue dye #5 allergy, which is almost never clinically relevant, but rarely will help me problem solve with decision trees and algorithms.

In order to remain relevant, EHRs must redesign how they function to support physicians in their professional endeavors, the way technology supports us in the rest of our life.