
Ask HN: What would it take to make a great Electronic Health Record(EHR)? - seanseanme
I realize this is a niche topic, so apologies in advance.<p>In my personal experience, EHRs do not make me feel like I am doing a better job and take time away from interacting with patients (which I love).<p>Secondly, EHRs have been linked with physician burnout.  http:&#x2F;&#x2F;www.beckershospitalreview.com&#x2F;healthcare-information-technology&#x2F;mayo-study-links-ehrs-with-physician-burnout.html<p>There are just so many issues that I just wonder why it is not a richer area of innovation.<p>As a dermatologist, my gripes are mainly about the provider facing interface, but there are so many things to improve upon in this area alone.<p>To name a few:<p>Data entry takes forever.<p>Coming up with a longitudinal view of any specific problem requires piecing together sequential notes which takes far too long.<p>Patient access to their own charts without context sometimes leads to misunderstandings. Like documenting a finding of S.O.B. (shortness of breath)<p>And that is ignoring many other equally important perspectives.<p>So I ask: what do you perceive as the hurdles of this sector, and what would the process be to come up with EHR 2.0?
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PaulHoule
As a doc you probably have a better idea of the problem that most of us.
Probably the back end has to be universal but can you make a front end
tailored for a dermatologist?

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seanseanme
It is an interesting question, because some companies have made specialty-
specific front ends to serve dermatology, for instance, but even at that
resolution it ignores a lot of work flow variability between individuals.

I was thinking about the available EMRs out there right now and find that most
of them are basically digital versions of the old paper medical chart (with
some bells and whistles). None really try to improve upon the process of
flipping between pages (or screens) to gather data or track changes , which
seems like a pretty big opportunity.

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PaulHoule
Look at the old expert systems such as MYCIN, Digitalis Advisor, etc.

These are not so much EMR systems as they are systems for structured decision
making, but along the way of doing what it does, that kind of system is going
to guide you through a workflow and leave structured documentation.

There is a huge literature on Business Process Management Systems that has a
strong connection w/ the old expert systems because the production rules used
in expert systems are very good for long-term workflows that involve both
human and automated actions. Said systems are designed so the workflows are
much easier for domain experts to make than it would be to create the
equivalent in a conventional programming language.

Also I am thinking of an allergy&asthma practice that has four docs and a
bunch of NP's, RN's and other people that has a very structured process that
has a lot of paper involved but really could be automated.

Write me at paul.houle@ontology2.com and we can talk more.

