Short Link: http://j.mp/5CRUr8
Today’s trend is to add more and more EMR features. At first only the most important features are created and special attention is paid to simple and elegant usability. However, each additional feature adds less and less value, until adding features actually reduces the total value of having a pediatric EMR in the first place.
This phenomenon of feature creep or “featuritis” is well known. It is:
“the proliferation of features in a product such as computer software…Extra features go beyond the basic function of the product and so can result in baroque over-complication rather than simple, elegant design.”
and
“adding feature upon feature until the simple things you used to do are no longer simple, and the whole thing feels overwhelming…
The solution to “featuritis” is to:
Give users what they actually want, not what they say they want. And whatever you do, don’t give them new features just because your competitors have them!”
The following short three minute video illustrates the point (timed transcript below if you’d prefer to skip the video). The actual charting by Dr. Copenhaver of a simple straight forward pediatric encounter only takes 37 seconds, from start to end. One pediatrician who uses the EncounterPRO Pediatric EMR Workflow System famously says “If I can’t chart a routine otitis media encounter in under 30 seconds, I know something is wrong!” (As in, the server is slow today, tell someone to fix whatever needs to be fixed.)
By the way, the comment that using a finger instead of a mouse takes only a third of the 37 observed seconds only initially seems implausible. There are 17 clicks. Can you tap your finger 17 times in 12 seconds? Certainly you can. Wait, you protest, what about tapping a finger in *different* places? Nope, can still be done in 12 seconds. Musicians do this sort of thing all the time. As noted in a previous post, the cognitive motor skills necessary for data entry in a pediatric EMR workflow system more resemble that of a piano player than a knowledge worker. (By the way, I’m planning on a future post that critiques EMR data and order entry from the point of view of psychological models of musical cognition, learning, and motor skill.)
I have nothing against ten minute-plus on-line demos of every jot and tittle of what a pediatric EMR can do. Back in 2002 it took an act of congress to get an EMR demo (the basic issue was that folks resented having to register and provide lead information *before* they even got to see a demo and decide whether or not they wanted to provide their personal information). I believe that my “one click” demo of a pediatric EMR workflow system pioneered the self-running browser-hosted voice-narrated EMR demos that are now common (note the “Version 4.0.02 (10/23/2002″). (Send me a link if you know otherwise.)
What most pediatric EMRs miss is the common sense rule that the simple should be easy and the complex possible. But making the complex possible should not make the simple hard. That is the lesson of the need to avoid the downhill slope side of the Pediatric EMR Featuritis Curve.
Whether for the search engine robots, for purposes of improved Web accessibility, or just for the speed readers who find videos an inefficient use of their time, here is the time-tagged, color-coded, word-for-word transcript of 37 seconds to chart a routine pediatric encounter.
| Time | |
| 0:00 | Let’s chart a patient! |
| 0:03 | The set up is that the nurse has already seen the patient, brought him back to the examination room, taken a chief complaint, taken vital signs, and has completed her job |
| 0:16 | I’m finishing up with the patient in exam room four, I look at my office view screen, and I notice that Tommy Smith in room one has been waiting the longest to be seen by me, that’s how I know who to go see next |
| 0:30 | I open the chart and I notice that Tommy has a sore throat and his temperature is 102 and that his strep is positive |
| 0:39 | It’s time to go see the patient |
| 0:41 | I open the door, introduce myself and start examining the patient while taking a bit more history from the mother |
| 0:50 | After examining the patient I formulate a diagnosis and treatment |
| 0:57 | Now it’s time to chart the patient |
| 1:01 | So let’s look at our watches (everyone with a second hand) let’s go ahead and start… |
| 1:07 | …NOW… |
| 1:08 | I open the chart |
| 1:13 | Chart my physical exam, my pharyngitis exam |
| 1:19 | Chose my diagnosis of strep pharyngitis |
| 1:25 | Make my treatment duracef and follow up in 3 days |
| 1:31 | Write my prescription |
| 1:33 | Edit my follow up if necessary |
| 1:37 | Have created a beautiful chart |
| 1:42 | Check my billing |
| 1:44 | And I’m finished |
| 1:45 | (Audience: Exclamations, 37 seconds! Wow!) |
| 1:50 | As you can see I did this with a mouse in 37 seconds |
| 1:56 | In reality, with a finger or a stylus you can do this in about a third the time |
| 2:03 | I know this because when I’ve looked at timed studies of our current physicians’ charting at pediatrics or family practice, the average chart for a sick visit is 28 seconds. |
| 2:20 | Not bad! |
| 2:22 | A well visit is actually around 55 seconds, there’s more to chart! Make’s sense.) |
| 2:30 | Our physicians can chart quickly, they can chart accurately, and more efficiently. The end result is that patients move through your practice much faster, creating the opportunity to see more patients, spending more time with individual patients, or going home early |
| 2:58 | Thank you! |
P.S. Less is more.
