De Novo Emr Blueprint - Business Office I: Stating The Obvious

Our ancestors began using tools millions of years agone together with humanity assumed command of the planet it lives on through a succession of tools ranging from sticks together with stones all the means to iPhones together with drones. The basic procedure for discovering or inventing tools hasn’t changed much over the millennia, together with it follows ii basic patterns. Either an existing artifact is examined for fitness to diverse purposes until i such purpose is discovered accidentally or through organized efforts, or a employment is identified together with a tool is together with thence invented, or located, to solve the problem. The employment itself could live something that was idea impossible before, such every bit flying, or a to a greater extent than mundane wish to trim the elbow grease together with expand the capabilities associated amongst an existing activity, such every bit moving goods from i house to another. Tools tin give the sack guide maintain express effects, revolutionize an entire economical sector or tin give the sack alter history, together with some tools tin give the sack guide maintain harmful effects that must live balanced amongst the benefits they offering for the intended task. Tools unremarkably undergo long processes of change, improvement together with expansion, together with sometimes the evolving tool looks nada similar the original invention. Why are nosotros talking nearly tools here? Because programmable computers are tools. The reckoner hardware is similar the hammer caput together with the programming software is similar the hammer’s grip (more or less). And EMRs are i such handle.

Let’s imagine that nosotros are software builders together with nosotros guide maintain a wish to aid doctors deliver patient care. And let’s farther assume that we, together with our prospective customers, examined all the existing tools out at that spot together with works life them non quite jibe for purpose. Let’s also assume that nosotros are non suffering from delusions of grandeur, guide maintain the humility to acknowledge that nosotros don’t know how to cure illness together with guide maintain no involvement inwards global social applied scientific discipline initiatives. Let’s imagine that nosotros are the misguided founders of a modest social describe of piece of work organisation interested inwards doing good past times helping others do adept things.

The next is a theoretical exercise inwards software production pattern for the shrinking marketplace niche all the same subscribing to Sir William Osler’s views on medicine. Therefore our starting signal volition live fixed past times the supposition that medicine is “a calling, non a business” together with that medicine is to rest a “humanitarian together with respected profession” concerned amongst “diminishing human suffering”. Since nosotros are non out to develop drugs or devices, the overriding destination for our imaginary software is to improve patient care. But inwards enterprise to improve something, nosotros root demand to at to the lowest degree sympathise what that something is. So what is patient care? For simplicity of illustration, let’s farther constrain ourselves to primary care, because it is belike the most mutual together with best understood type of patient care.

Patient aid is a longitudinal activity occurring over varying periods of time, but it is non continuous; instead it is a chain of discrete units of service unremarkably called encounters, which may or may non live subject on each other. Encounters tin give the sack live proactive, reactive, physical or virtual. The mechanics of a patient catch inwards primary aid is real simple. Patient comes inwards (or not), patient relates problems (if any) to physician, physician formulates diagnosis based on patient narrative, physical examination, diagnostic measurements together with lastly suggests therapies to resolve, alleviate or foreclose suffering from problems. Patient may or may non concur amongst suggestion. There are 3 major parts to this procedure - gathering of information, synthesis of data together with human relationship edifice - together with each part has a real clear purpose. Note that documenting the events is merely a corollary to the primary process. Sounds simple? Not quite.

While this is the electrical flow practice, many production designers are designing software for what they recall patient aid should be, adding together with removing parts to together with from the electrical flow process, or disregarding the existing procedure inwards its entirety. To sympathise why this is a problem, let’s recall nearly Microsoft Word. Manny decades ago, writing consisted of a blank canvass of newspaper together with a writing instrument, quill, pen or pencil. First the typewriter removed the piece of work needed to shape each missive of the alphabet past times hand, together with and thence the reckoner removed the demand to guide maintain a physical slice of paper, together with instead gave us an interplanetary space release of blank sheets, amongst obvious benefits to the user. What neither of these inventions did is to redefine the authoring process; yous all the same guide maintain to selection something to write about, do your enquiry together with “write” it down. The give-and-take processor makes it easier together with cheaper to write, to create mistakes together with to brand your masterpiece hold back appealing. Now imagine what would guide maintain happened if the creators of Microsoft Word would guide maintain decided to live a flake to a greater extent than helpful together with gave yous a serial of dropdowns together with buttons to select together with refine the discipline of your writing together with and thence plopped inwards a prewritten article, which yous tin give the sack forthwith edit to your liking. Who would guide maintain used this contraption? People who guide maintain no describe of piece of work organisation writing inwards the root place. As is truthful amongst medicine, inwards software pattern sometimes less functionality is improve functionality, peculiarly when the extra functionality is paternalistically dictated past times the purveyors of software.

Back to our niggling project, what do nosotros guide maintain thence far inwards the means of requirements?

1. System shall assist amongst gathering data from diverse sources (TBD) at the signal of care
2. System shall assist amongst synthesis of said information
3. System shall assist amongst patient-doctor human relationship building

Note that since nosotros are non edifice a replacement for the user, our organisation is an assistive engineering organisation together with nada more. These requirements are non granular plenty to start programming from, but are at that spot to e'er hold back upwards to, together with catch if everything nosotros do serves i of those basic goals. If it doesn’t, together with thence it should non live built. Note also that nosotros are non questioning the user’s “workflow”, wisdom or professional person decisions. We are aiming to render a express service, together with volition move out “fixing wellness care” to to a greater extent than ambitious folks. To whatsoever laid of basic requirements, I similar to add together the prime number directive of software development, which is a full general alarm for subsequent designers, architects together with programmers:  

4. System shall non brand the employment harder to perform for the user

The adjacent stage of pattern volition accept our primary laid of requirements together with intermission them downwardly into concrete software tasks (and no, #3 is non a joke). To do that, i should sympathise inwards infinitesimal detail, together with preferably practice, patient care, peculiarly for the purpose of observing the constraint imposed past times #4. The creators of Microsoft Word, together with all other straight to consumer software builders, guide maintain a much easier fourth dimension amongst this portion, since everybody writes. Those who construct software tools for domains that they are non familiar amongst guide maintain a vogue to brand also many assumptions based on random together with infrequent encounters amongst said domain (e.g. I accept my kids to doctors all the time, I had to move to the ER in i trial together with I know how it works, etc.). Translating the inwards a higher house requirements into concrete specifications should entail many months of research. Assuming nosotros guide maintain that nether our belt, nosotros are ready to motion on to the adjacent step.

Even to the untrained eye, our root 3 basic requirements speak volumes. #1 looks similar something computers tin give the sack do real well. #2 looks similar something that computers may live able to do real good inwards the future, but correct forthwith it embodies lots of difficulties together with temptations best avoided. #3 looks ridiculous to some, but real promising to younger folks who define relationships through software apps. Another great affair that practically jumps out of the page is that nosotros don’t guide maintain to satisfy all 3 requirements all at in i trial inwards enterprise to guide maintain a useful product. Thus our niggling projection lends itself real good to an agile evolution model where nosotros tin give the sack guide maintain successive serial of modest releases that are useful to our users from the instruct go.  Another hold back at those full general goals reveals that nosotros could do goodness from placing some boundaries on the magnitude of our projection to avoid the release i pitfall of all software projects – reach creep, or consistently succumbing to the temptation of adding i to a greater extent than niggling thing. To do that nosotros should look, inside our reach of service, at what patient aid is not.

• Patient aid is non a synonym for world health.
• Patient aid is non a fiscal transaction.
• Patient aid is non lifestyle coaching.
• Patient aid is non a commodity (at to the lowest degree until people move a commodity every bit well).

And merely inwards instance nosotros were non specific plenty inwards our definitions, this software is for physicians administering aid to an private patient. We are non designing tools for staff, billers, payers, employers, federal or nation agencies, together with no, nosotros are non edifice tools for patients. Although requirement #3 may drive us to address the patient perspective to the extent that it is pertinent to physician activities, our (paying) client persona is the Dr. (we’ll expose some APIs for the ease of the world…).

So let’s tackle the biggest bang for the buck first, together with instruct started from the top. Part II volition endeavor to define a manageable laid of specifications for our imaginary product. In the meantime, experience gratis to contribute to this idea process….