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Thoughts, comments, news, and reflections about healthcare IT from Microsoft's worldwide health senior director Bill Crounse, MD, on how information technology can improve healthcare delivery and services around the world.

Do we need to re-imagine the electronic medical record?

Do we need to re-imagine the electronic medical record?

  • Comments 4

imageThe electronic medical record is here to stay. It would be foolish to think that the healthcare industry could ever go back to paper. Yet I know that the majority of my clinical colleagues aren’t especially happy with the electronic medical records systems they are being forced to use. Here on HealthBlog, I’ve frequently written on this issue and shared stories about some of the EMR solutions I’ve seen over the years during my worldwide travels. As the old adage goes, “if you’ve seen one EMR, you’ve seen one EMR”. But some EMRs are definitely better than others, and more often than not, some of the most innovative I’ve seen are solutions not in America, but overseas.

Many of today’s EMRs grew out of electronic billing systems that were only later adapted to capture clinical information. Even some of the best of today’s solutions are nothing more than a digital representation of the paper chart model. As information communication technology has advanced, the EMR has often failed to catch up. I’ve frequently asked the question, why don’t EMRs make better use of rich media capabilities including audio, video, and immersive graphics? And why isn’t information in the EMR presented in a format that more closely fits with the way physicians work and think?

imageOne solution I’ve been following over the years is from a company based in Norway. The company, Imatis, has  always been pushing the boundaries on what the modern electronic clinical record should be. Their focus is both contextual and highly visual. They make the most of what contemporary information technology can deliver through an intuitive, immersive graphical user interface.

imageTheir newest iteration is something the company calls Imatis Visual Health. Instead of pages of information organized as discrete data points, text fields, and chronological events, Imatis Visual Health takes an entirely different approach. Information is organized around human anatomy and organ systems. The entire human body is graphically represented on screen. Each area calls out relevant information about the patient’s health history, chronic diseases, laboratory tests and medical images and how all these interrelate with the patient’s current health status. As Imatis company literature reports, “By using the human anatomy as the main paradigm to organize and browse in the Patient Record, IMATIS Visual Health provides an intuitive and fast navigation system for all users who can then communicate, understand, and see the content of medical articles or Electronic Medical Records efficiently and effortlessly”.

imageI don’t know about you, but I’d like to see much more of this forward-thinking approach to the design of electronic medical records. I would challenge all vendors to start thinking outside the “paper chart box” and bring to market tools and technologies that enhance rather than burden clinical workflow and knowledge transfer.

Visual Health, is a browser based solution that works on desktops, laptops and mobile devices running just about any of the most popular browsers and operating systems. It is based on a software technology that offers a unique combination of scalability and flexibility to deliver intuitive user interaction and information management.

The bar has been set. Who’s next?

Below, you can view a short video that shows how Imatis Visual Health enriches the electronic medical record.

   

Bill Crounse, MD       Senior Director, Worldwide Health      Microsoft

  • interesting, but we must not forget that there are participants in the processes of healthcare that do not have a medical background. Administrative staff cannot be expected to use anatomic models to handle EHR data, and since clinical and administrative workflow are part of the same meta-process, I'd expect to see the possibilities to use both approaches working with EHR data.

  • Portal to existing ER

    Visual Health is a Portal that runs in a standard web browser, using html5 technology and Java Scripts.  The application is not replacing any existing Electronic record, it is only a portal and a alternative supplement to the user interfaces that is offered by the local Electronic Record vendor already installed in the hospital.

    Content mapping

    Visual Health provides a map from standard medical dictionaries such as MeSH or ICD-10 onto the human anatomy. It automatically links medical conditions to relevant body parts. This creates automatic illustrations of content as well as an anatomical indexing of key information that can be retrieved by interacting with the body directly. Supported dictionaries include MeSH, ICD-10, SNOMED CT, MedDRA and more generally any dictionary in the U.S. National Library of Medicine Metathesaurus. The quality of the mapping is regularly improved by a clinical team.

    Cloud

    IMATIS Visual Health can be run from standard Cloud installations as Microsoft Azzure, where the content mapping tools build the bridge to the local ER installations in the Hospital.  It is also possible to do local installations.

    Denmark

    In Denmark they have a National Electronic Record (E-Journal) where patient data can be accessed both from patients and doctors across all Hospitals in Denmark.  The IMATIS Visual Health is connected to the Danish National E-Journal, so the doctor have access to the ER from all the Danish populations independent of the local hospital electronic record.  The local ER in the hospitals are synchronized with the national record on regular basis.

    www.imatis.com/.../Natus_features.html

  • EMR systems tend to be large and heavy structures, often operationally closely connected to the HIS  system. They are usually good containers of most of the total clinical and administrative information about the patient. In my experience, the clinical situation often demands only partial access to these data, as well as specific data from other databases like PACS, pathology and labs, for optimal and adequate clinical action. In my opinion, a good solution to such information needs in the clinical situation, is to have highly configurable systems available to extract the most relevant information to the real clinical setting. A quick orientation at the avatar method of displaying diagnoses and episodes should give a quick preliminary orientation of the complexity of the patient history. Imatis Visual Health seems to be a very promising clinical information tool in my opinion.

  • I see two main purposes of contemporary clinical knowledge sharing fulfilled with the Imatis Visual Health.

    LOGIC - Western medicine is based on anatomy and pathoanatomical findings.  Accordingly it is intuitively correct and logical to use anatomical indexing of clinical information.

    AGGREGATION – Health informatics solutions and data availability is threatening to drown clinician’s minds with data overflow. Aggregation to graphical representation of the underlying logical structures can provide information to allow for quick overviews of patients situations.

    It should be appreciated that some of the information processing is mowed from the minds of the clinicians to the designers and coders of the system. Imagine the immense work applied to implement semantic STANDARDS in this project. We should all applaud, respectfully!

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