Explorations in the Design and Implementation of Clinical Information Systems
One of the most difficult aspects of creating clinical systems is rendering clinical concepts in a way that allows computers to reason with them. This is the central challenge in areas such as decision support, workflow management, and interoperability. Building smart EHRs requires computable concepts. Let’s consider a simple example using test orders. Version 1.0 [...]
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While there have been many books that I’ve enjoyed, only a few have truly resonated with me. Consilience: The Unity of Knowledge, by E.O. Wilson, was one such book. Wilson states: Consilience is the key to unification. I preferred this word over “coherence” because its rarity has preserved its precision, whereas coherence has several possible [...]
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Dealing with abnormal test results was one of the main misery points during my years in practice. It was too easy for things to fall through the cracks. When clinicians receive an abnormal result, the usual steps are: review the patient’s chart, decide what to do, and take action. Proper management may require additional tests, [...]
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For the last few weeks or so, I have taken time from other activities in order to take a fresh look at EHR design. This was not on my to-do list. It came about because of my interest in how usability, workflow, and other design issues affect implementation success. EHR implementation is a source of [...]
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The newly proposed rules for EHR certification, referred to by ONC as Certification Criteria for Electronic Health Record Technology, 2014 Edition, contains a few pleasant surprises that bode well for EHR users. There are provider-friendly changes in how CEHRT is defined; a new security requirement that may help with data breaches; and comments on data [...]
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In my experience, the decision to implement an electronic health record is usually an attempt to solve ongoing practice problems. Whether or not an EHR successfully meets expectations depends on the complexity of the problems and how appropriate an EHR is for solving them. Some problems are straightforward and readily solved by implementing an EHR–remote [...]
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For an outside consultant, one of the most challenging aspects of helping an organization through an implementation is dealing with the attitudes, expectations, and beliefs of stakeholders. In my experience, turf battles and organization politics cause more project failures than technology issues. More often than not, stakeholders bring a range of backgrounds and viewpoints to [...]
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Making an EHR sale takes time and resources. Once a sale is made, client sites provide vendors with a steady stream of income. Client sites that decide to switch from one EHR to another will find vendors less than eager to see them go. Though data migration options should be included in contraction negotiations, it [...]
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Though I have not played in years, Diplomacy is my favorite game. It is a wargame based in Europe at the start of the WWI. The most interesting games occur when seven players are involved (the game’s maximum). Each player begins the game controlling only three or four supply centers; winning requires control of 18 [...]
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The EHR Science Blog presents the musings of Jerome H. Carter, MD, CEO of NTM Informatics, Inc. He is also the editor of Electronic Health Records, Second Edition, published by the American College of Physicians.
Posts on this blog are the personal views of Dr. Carter and do not reflect the official policies or positions of the American College of Physicians.