Part II: Setting Expectations Works For GPS, Why Not EMRs Under Meaningful Use?

Dec. 28, 2011

Going back to my analogy in Part I, having a GPS for guidance while driving, even when its recommendations are not followed or even needed, is a good thing. It may lead to the safest and best way to reach your destination, but at the very least, it provides choices to make a more informed decision.

Part II: Setting Expectations Works For GPS, Why Not EMRs Under Meaningful Use?

(Part I here)

Going back to my analogy in Part I, having a GPS for guidance while driving, even when its recommendations are not followed or even needed, is a good thing. It may lead to the safest and best way to reach your destination, but at the very least, it provides choices to make a more informed decision. For example, a GPS can monitor and communicate traffic ahead en route, information that is often not available through other means.

This is certainly the case when the GPS identifies the optimal path or road, but does not actually meet the needs the driver has in mind. As we all know, GPS isn’t infallible.

Recently, I was driving to an unfamiliar destination. Before starting out, I checked a Smartphone app (Yelp) and found that several folks commented they ended up driving in circles trying to find the same location using their GPS.

It turned out that three separate roads seemed to converge on the address. However, that’s because GPS interprets locations in two dimensions. In reality, two of the routes placed drivers on roads that passed over their destination, but didn’t actually intersect it. If GPS worked in three dimensions, that would not have happened.

In working with my team on our EMR, I’m reminded that a “three dimensional approach” is a necessity. In simpler terms, the system must have depth to create value and drive adoption.

We need to create system expectations based on this type of mindset as it applies to clinical decision support. This is true for Stage One MU, and it's especially true given what we know about Stage Two and beyond, where the care plan, goals, and prevalent clinical conditions will take a more central role.

EMRs will not have adequate documentation for results of diagnostic testing to make fully informed recommendations in every instance. That’s a given. Furthermore, it's become increasingly clear that some electronic recommendations, offered in a broad brush fashion, based on incomplete (GPS two dimensional) knowledge – perhaps driven by a single problem on the problem list – will need to be interpreted by the clinical provider to achieve an adequate decision-making process.

Therefore, as I wrote earlier in this blog series, similar to GPS, the EMR and its recommendations are needed decision support for physicians who still make the final decision. This needs to be an expectation set for providers, as well as nonclinical senior executives, designers and architects of EMR systems and, perhaps, even patients.

In the era of Meaningful Use, we’ll need systems that, in a respectful manner (see my previous Butler Model post, http://bit.ly/ButlerModel) are helpful, and that in some ways mirror but transcend the performance capabilities which previously existed in the paper world.

Although some share this expectation today, it’s all too easy to dismiss the EMR, clinical aids, and their workflow role in the era of Meaningful Use because of inappropriately set expectations. However, in the era of Meaningful Use, EMRs will need to be used universally. So as I return to work with my team on the evolution of EMR technology, let’s also commit to setting the proper expectations for all. Stage One awaits us.

What do you think?

Joe Bormel, M.D., MPH
CMO & VP, QuadraMed

Part I: http://bit.ly/GPSandEMR
Part II: http://bit.ly/GPSandEMR2
Previous post: http://bit.ly/MUKayak

Civilization advances
by extending the number of important operations
which we can perform without thinking of them.
  - Alfred North Whitehead