Here’s a little something to infest your daydreaming mind with:  What if physicians were allowed to bring their own EHRs to work?  I’m not talking about bringing two tons of Epic or Allscripts wherever you go, but something light that simply allows them to document and communicate with other people and systems as needed.  Physicians could no longer complain about why they can’t use EHR X instead of EHR Y, because it would be their own problem why they didn’t make that decision.  Even better, they could change out their EHR if they didn’t like it without getting approval from anybody.

Ok, ok, ok…here are a couple of reasons this can’t currently work (so quit scoffing over there) and what can be changed so it can:

  • There is no common API:  There are a plethora of apps in both Android and Apple’s app stores that all do the same thing and work within their environments seamlessly.  There are also a host of plugins that work utilizing a common API in browsers.  I could also write a simple application that goes to a website and queries an open database there.  The technology is in place to make this sort of thing happen, but we haven’t yet agreed as to what it is.  HL7 is great and all and would make a fantastic sick bay floor name on the USS Enterprise, but it takes a lot of manual labor to set up every connection.  We have common terminologies (SNOMED, ICD, LOINC, RxNorm etc.).  Let’s build an open source platform based on communicating using those languages and then bake that into new products.  I will humbly submit (again) that Meaningful Use should have taken the route of establishing what infrastructure HIT runs on instead of what features and EHR has.
  • Who’s going to support this? IT?:  IT would be in over their heads trying to learn all of the new applications.  Let’s do what they do currently when a physician asks to bring their own device: support them in their initial connections, but after that, it’s in the hands of the vendor.  This might inspire vendors to focus a little more on the quality of the product they are putting out if they have the risk of getting called by hundreds of physicians everyday, eh?  I would also add that this might influence more physicians to operate independently since they don’t necessarily need a hospital organization for as much as they did before.

On the flip side, the technology is there, the agreement on common terminologies is there, and common patient record formats are also there thanks to Meaningful Use.  Heck, let’s let some of the legacy EHR carriers be part of the infrastructure.  Building things that don’t change is what they’re good at.  Let’s leave the user interface part to some new blood with agile development skills.  Just remember, you heard it hear first*.  Send me a note if you are getting started on this, because that is something worth investing in.

*Upon some serious Googling I have found a single internet user in an article comment that came up with this term before I did, but that’s it!  I have fleshed out the idea for further consideration.

4 Responses to “BYO…EHR”
  1. John Lynn says:

    The idea is interesting. Although, what you describe is almost more bring your own EHR interface as opposed to bringing the entire EHR. The doctor really just needs an interface they enjoy which can push the data to whichever EHR backend an organization is using. The concept is really interesting, but also really hard to implement.

    • aaronberdofe says:

      Well said, John. I think an “EHR backend” is a little bulkier than I’m imagining though. I assume you are anticipating a database of some manner to hold all the patient information, account numbers, etc.? However, if you have a collection of independent applications operating with the same communication protocol, who says there needs to be a centralized backend to hold it all together at all? Another thing going against this idea is that our healthcare system is very centralized around hospitals and they generally do everything they can to keep it that way.

  2. I hate to toot my own horn but I’m that “single internet user” who verbalized this idea as the Nerd Doc.

    It’s an idea that has been on my mind for several years, but only intensified as I started working for a hospital health system that is making 100’s of physicians from different specialties all use EPIC eventually.

    This has disasterous implications for niche specialties that depend on highly specific types of documentation. It also leads to enormous provider dissatisfaction.

    But when the buyer of the EHR is not the user of the EHR, this is bound to happen. The “job to be done” (to quote Horace Dediu) of the EHR is to maximize documentation for billing, coding, and legal compliance.

    -Suleman Bhana, MD

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