Rheumatology-Specific EHRs: What's Right and What's Not (Yet)


New rheumatology-focused electronic health record systems make recording patient assessments easier. However, there's still plenty of room for improvement

Not using a rheumatology-focused electronic health record (EHR) yet? There's no question that, as  rheumatologists confront some of the most complex, difficult-to-diagnose conditions in medicine, an EHR well-designed for rheumatology could be great for tracking unpredictable symptoms, monitoring complicated treatment plans, and assessing outcomes.

But does it exist?

According to a study by the market research firm KLAS (Ambulatory EMR by Specialty Study 2012: Finding the Fit,), most specialists including rheumatologists want EHR systems that address their specific needs and requirements. But it says that today's specialty EHRs fall short, ranking lower in satisfaction (6 vs 7 out of a possible 10) than more generalized tools.

“It is extremely concerning that the average satisfaction in existing EHR implementation is alarmingly low,” said John Bartley, MD, chief medical director for cloud-based EHR vendor iPatientCare. He blames this on a disappointing record among current EHRs for providing specialty-focused, customizable features, for communicating adequately with other providers (labs, pharmacies and other doctors), and for offering satisfactory customer support.

The Benefit of Rheumatology-Focused EHRs

The American College of Rheumatology offers guidance on available rheumatology-template EHRs, and numerous vendors including Cerner, CureMD, 1st Provider’s Choice, and OmniMD do market template-based EHR systems customized for rheumatology.

Some experts say that specialized EHR systems are easier to learn quickly. Other useful features:

Stylus entry: Some systems, including Greenway, let providers circle joints with a stylus – harking back to pen and paper – to indicate problem areas.

Targeted popups:  A recent study from Roudebush VA Medical Center in Indianapolis found that these alerts often target pharmacists, not physicians. Physicians get confused and ignore them, potentially jeopardizing patient safety. A specialty-specific EHR could reduce this problem by offering only popups relevant to the user, the report said.

Pre-populated templates: Along with condition-specific decision support, prespecified options make it easier to complete face-to-face patient assessments. And drop-down menus that offer diagnosis variables may improve on keying the information in manually. (Experts say that's true only if the user doesn't need to click more than three times on a list.)  

“One would think that having drop-down menu options based on those pre-coded by other rheumatologists might make charting super easy and fast,” said Rebecca Muntean MD, a rheumatologist at Providence Health & Services in Washington. “At the time same, it might lose the individualistic nuances that each patient with the same disease might have.”

Many industry leaders stressed the importance of having rheumatologists participate in EHR design and coding for their specialized systems. For example, Modernizing Medicine’s new product, EMA-Rheumatology, asks condition-specific questions based on content written by a panel of rheumatologists.

What Rheumatology EHRs Still Need

Other specialty features that knowledgeable sources say would be especially useful in rheumatology:

1.  Collecting patient-reported health assessments and disease activity information,

2.  Fields to capture therapy attempts that were unsuccessful, and

3.  Enhanced access to laboratory and diagnostic imaging reports

But the key missing ingredient, perhaps, is a way to make it worth rheumatologists' investment of the time and attention to customize and then use a specialized system.

According to Vandana Ahluwalia MD, rheumatology chief at William Osler Health System in Ontario, Canada, getting providers to adopt a rheumatology EHR has been a stumbling block.

“We surveyed our rheumatologists to see if they were actually using our new EHR system and how they felt about it. We assumed they were expert or super users,” she said. “The majority said they weren’t using it.”

The hang-up? Implementing the EHR correctly demanded a large investment of time and energy to program the system. Most rheumatologists in the practice weren't willing to shift their focus away from active patient care.

Ultimately, Ahluwalia predicted, implementing rheumatology EHRs will help create more consistent patient-care delivery across the specialty.

“It’s really important that we enter data in a standardized way so we can start to reduce the variation of care delivery,” she said. “We must create a way in which we all do the same things and do it according to set criteria or guidelines that deliver the best possible care that we can.”


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