One Size Fits None

In my world of technical implementations, no two clients or projects are the same. Even within the same practice, each individual client is unique and values different things. In a perfect setting, this would translate into a tailored EHR implementation approach, which focuses on the needs of each provider rather than a single practice-wide workflow. But in reality, most EMRs take a “one size fits all” approach.

This conventional approach usually requires a regimented series of point-and-click options that generate a canned note completely devoid of the nuances of practicing medicine. It also turns the provider into nothing more than a very expensive data entry person. Why this approach has lasted this long is a mystery not only to me, but to the very physicians using these systems. That sentiment is evident in many surveys and blogs where physicians have openly expressed their discontent with current EHR technology and, by extension, the government’s Meaningful Use program.

For example, take a mid-sized orthopaedic practice. This practice may consist of a podiatrist, rheumatologist, spine specialist, PT/OT, as well as orthopaedic providers. Prior to having an EHR, their reporting methods may have included a combination of dictation, electronic templates, body diagrams or just plain pen and paper. However, the conventional approach—which forces the practice to follow one standard way of reporting—disrupts and frustrates everyone, and may reduce patient volumes in the long run.

The simple solution would be EHR technology that adapts to each provider’s workflow. Standardizing clinical support and back office functions can still allow for flexibility in each provider’s choice of encounter documentation. The podiatrist can use his specialized preprinted diagrams for his encounter and scan into the chart. The spine specialist can dictate as she always has. The tech savvy rheumatologist is able to drag on into an electronic document. The anti-change provider can hand write on a form that gets scanned into the EHR, and is automatically routed to the patient’s chart.

The truth is—I work for a company that provides this flexibility. My company recognizes that the “one size fits all” approach is as nonsensical as giving every patient two aspirins without finding out why the patient is ill. My advice to every physician looking for their first EHR, or looking to replace a failing EHR, is to ask the tough questions when it comes to workflow. Ask for an explanation of how you would do your daily work in the new system. Also, if you are making the decision for a group, check how their workflow will be affected. In the end, you may avoid a costly mistake.




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