Monday, May 6, 2013

Discharge Module Wish List

Discharging patients in real-time should be quick, swift, and efficient.  It should not involve a labor intensive, redundant process resulting in unnecessary delay.  Completing the multiple necessary items should be possible with a few routine mouse clicks. 

Unfortunately, many of the EHRs in use today do not understand Emergency department work flow (or physician work flow and thought process in general); as a result, repeated, nested mouse clicks are often used, and these can take up to 10 minutes.  This time is better spent in actual patient care.

Indeed, many electronic health record systems do not distinguish the needs of the particular care-setting in which it is used.  Most importantly, emergency department, urgent care and outpatient settings have some similarities in their discharge processes, but for inpatient settings, discharge is necessarily more complex, especially due to recent regulatory penalties regarding re-admissions.  Hence, a "one-size fits all" software solution where inpatient discharge procedures are imposed on care-settings with rapid outpatient turnover, do not work!

One big issue with many EHR implementation is physician activities and work flow are poorly understood by IT developers, which may cause unnecessary redundancy in tasks when using the program.  Even Amazon and Google understand human ergonomics better than has been demonstrated overall by the EHR industry.  For example, instead of data accumulated by the provider being automatically transferred to the discharge information (i.e. follow-up physician, prescriptions, date of follow-up), complex actions, such as copy and paste or (worse) scanning, are employed.  This also happens in the reverse direction where data put into the  discharge paper-work is not auto-transferred, or even appended, to the medical record.  This leads to double work and difficulty in figuring out what actually happened, when reviewing the chart, if such a review of everything done is even possible.

And then, the patient often receives up to 10 pages of information with little hope of retention even if read.  It should be kept in mind that there are two basic pieces in the discharge process:  1. Instruction including follow-up plan- printed, with corresponding education provided personally by the physician and nurses, 2. Prescription - electronically created and transmitted Rx, or printed and given to the patient- including such necessary pieces as work or school excuses.


  1. Good One Dr. Bad.....very insightful, indeed.

  2. This will continue until the EHR developers stop blaming physician intransigence toward technology and start developing EHR for physicians, not for compliance. Stop developing them for data and start developing them as a form of communication, which is what the medical record really should be.
    Unfortunately, these cumbersome systems are being forced upon us so the developers have no incentive to develop one that is actually helpful to doctors

  3. Based on your insight, sounds like you are using one of the big 3 EHRs!