Who are we designing for?

What is Truly Meaningful Use?


Who are we designing for?


Post written by Andy DeLao


Last Thursday night I had the privilege of catching up with my friend and colleague Mike (@uscaspecialist) in Chicago.

In the conversation we ended up on the topic of EHR/EMR and meaningful use. We were discussing the ups and downs, as well as the promise of opportunities and the realized challenges of the EHR/EMR.

I then posed the question:

Why did we eliminate transcription?

The harsh reality is that someone sitting in a cube farm designed the EHR/EMR and all of those check boxes. A person with little to no knowledge of documenting a H&P (history and physical) while carrying a conversation with a patient.

meaningful-use-blog-postSomeone had a light bulb moment and made the assumption that if we can take the conversation, place it into the mandatory categories that are required to document and bill for a patient visit, and make it electronic that we can save time, energy, and money and improve the “patient experience.”

If we make physicians document electronically, make them check their documentation, and do it during the actual exam with the patient, then we can increase the efficiency in documentation, billing, and we can eliminate transcription.

Why did we eliminate transcription? We had a system that worked and we leaned it out.

Physicians would walk into a room. They would introduce themselves. Physicians would ask patients how they have been, how they are doing, how their family has been, and actually have a moment to build a relationship. Physicians knew how to carry a conversation and in the context of the story to identify the information they need to document the visit.

They would take 5 minutes and dictate the visit. Send it off to be transcribed. Double check it for accuracy. Sign it. Done.

We met the needs of the patients, the physicians, the payers, and the politicians.

Instead, someone shared a best practice that they implemented an EHR/EMR. They discussed how their physicians have checked all of the boxes. They met meaning use stage 1/2. They focus on the patient experience. They were lean and mean.

Everyone jumped on the bandwagon. Everyone ran to the bank.

In the midst, we forgot the 2 main lenses in the process: Patients and Physicians

We focused on taking information, making it digital, and putting it someplace to meet another set of checklists. The clinic visit is NOT just about information. The visit has always been about the stories shared between a patient and their physician. The dialogue. The meaning.

I believe there is an opportunity in the EHR/EMR process specific to clinic exams: have the right people focusing on the right level of work. Let physicians focus on patients. Let data entry people focus on checking the boxes.

That’s meaningful use.



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