Has AnyoneTried to Write their Own EHR?

[jmj11]

I know that I'm not the first to try and write my own EHR as I'm met others (physicians) who have. But I'm wondering if anyone here has tried. I'm using mostly Microsoft products (which have a lot of bells and whistles that most people never use). My motivation is that nothing exist in the market for my specialty. My goal is to get through a 90 minute consult with only a mouse but generate a detailed and beautiful document. I want to have Excel tables that monitor progress of major parameters and etc, and one click handouts, video clips and etc. However, I've spent two hundred hours on this so far. My son (PhD in computer science) is a great resource as well. But has anyone else tired to do this and if so, what approach did you take?

[UGoLong]

Wow! Where to begin?

 

Most of the EMR products you see now were the result of a doc writing his own. One doc started working on one when he worked at the VA and eventually formed his own small company. He eventually sold out to GE and now it's called Centricity. I shudder to think of how many thousands of hours that have gone into the product since.

 

You could probably write your own standalone product, but the bigger issue as we go forward is interoperability. EMRs have to work with eScribe, government rules to earn reimbursement ("meaningful use"), and -- ultimately -- sharing information across different EMRs. I certainly can't tell you that you can't do it, but it would be a huge long shot in my opinion.

 

I have a computer science background as well and have taken advantage of Visual Basic behind the Microsoft products to put together tools for our office. I have an app that generates surgical clearances with Word and another that generates billing information that we use for the patients seen in the hospital. They were fun to do, save a bunch of time, and don't have to work with anything else (though it would be nice if they did). You might want to look for what we used to call "islands of automation" rather than working on something like EMR, where the interfaces and outside requirements are huge and continue to change.

 

Good luck!

[burnpac]

The real question is why would you want to when there are off the shelf options that do what you are trying to do already. It seems a better use of 200 hours to do 130 consults and buy a product that already meets Meaningful Use. We have been using a iPad based cloud EHR (DrChrono.com) for a year and one half and I get through a plastic surgery consult checking boxes and using pull down lists (that have user defined custom text for ROS, PE, HX, orders, etc.), and then use the built in medical grade adaptive dictation to generate the HPI, focused PE, and the plan. There is no limits on the number of custom forms you can generate to adapt it to any type of practice. From my iPad, I send a fax to the referring practice, preop, etc,. of the beautifully formatted final consult, usually before the patient has even checked out in the front. It has built in e-prescribing, phone call logging, web interface for the patient, automatic appointment reminders, dictation, electronic fax, MU tool, iPhone software, built in Square integration for accepting CCs, and the vendor updates the software 2-3 times per month based on feedback from the user. It is pricey, by the month subscription (it starts out free, but if you want dictation, faxing, billing, etc., there is a fee associated with these -- well worth the cost), but it saves hundreds of hours of time annually and keeps us productive, doing consults and at the table, where we make our money. We are a very lean hospital based surgery practice, and it makes us look very professional for a small relative cost.

[jmj11]

I have both the meaningful use and HIPAA issues solved. I have taken many EHRs out for a test drive and none of them worked the way I wanted, plus they cost a arm and a leg in the long run. So if I end up spending 200-300 hours it would still be cheaper than what's available plus it would be tailored made for our practice.

[burnpac]

I have both the meaningful use and HIPAA issues solved. I have taken many EHRs out for a test drive and none of them worked the way I wanted, plus they cost a arm and a leg in the long run. So if I end up spending 200-300 hours it would still be cheaper than what's available plus it would be tailored made for our practice.

 

I understand where you are coming from. However, time is money, and as for the cost, you get what you pay for. I for one would rather spend my limited time generating revenue. One hour at the table, or one consult, more than pays for one month of my level of the EHR. I can't imagine a practice or specialty to which DrChrono can't be rapidly and seamlessly adapted. All template work is done, and I spend less than one hour a month tweaking and fine tuning my templates. You may have looked at it some time ago, but the current iteration is simply amazing and deserves another look. While DrChrono was very functional one year ago, The current iteration is light years ahead of the older versions and is continually being updated improved by the software engineers. They actually listen to the end-users.

[jmj11]

I will take a look at it. But we are so specialized that the EHRs don't fit well. I'm sure I've spent over a hundred hours on our present EHR writing Templates and etc. but it is still very cumbersome to use. Then I waste 1 hour a day on typing. Then when the system is down, I stay after work for 1-2 hours catching up.

 

The issue here is not about saving money but about having a better, well suited product that gives me the time to engage the patient eye to eye.

 

In our work, 97% of our exam are normal. The 3% that are not are usually within a small variation of abnormal. Right now, when the patient is walking out the door of the exam room, I'm faxing the note to their PCP, but that requires a lot of non-eye to eye contact. I want a menu driven, everything in one place, mouse click EHR. My beta testing (as I did yesterday) on my new consult produced a 5 page, detailed note with all the important things right up front and all of it with mouse clicks plus a couple of sentences I had to add.