Our Product Philosophy: Clinical First

It’s no secret. Just mentioning the subject of EHRs is enough to bring a blend of fury, resignation, and pain into the eyes of most doctors.

The healthcare industry has long touted EHRs as a revolutionary tool that helps physicians deliver quality patient care, but if you’ve ever probed a physician on the topic, odds are you heard an earful about how EHRs are nowhere close to delivering on that promise. There’s a steady stream of articles documenting this dissatisfaction, and we frequently hear these complaints from physicians. One internist we recently spoke with described her EHR experience as “demeaning” and “demoralizing”—and she’s a self-identified former EHR evangelist, of a new generation who has only practiced medicine with electronic records.

What has gone wrong on the path to creating transformational technology? And how can we as healthcare technologists build products that empower physicians instead of encumbering them? We believe it’s time to build a tool for physicians that focuses first and foremost on meeting their needs at the point of care. We call this approach “Clinical First,” and it is central to achieving the transformation the health care system so desperately needs.

At first glance, Clinical First may seem intuitive, even obvious. But take one quick look at the EHR industry, and you’ll see that Clinical First is far from the norm. The industry has instead adopted what’s best described as a compliance-centric approach. Nearly every EHR has been built to streamline billing and meet administrative reporting requirements towards improving the organization’s bottom line. But focusing on compliance forces physicians into a specific set of actions and limits the ways they can record and interact with critical patient information. Inherently, a compliance-centric system succeeds by dictating and restricting what a user can do. And when you limit a physician’s ability to navigate and document information in patient charts, you also limit her ability to provide tailored, quality care for her patients.

We need to stop building systems that put compliance before care. Instead, we as an industry need to adopt Clinical First as our rally cry and product philosophy.

Clinical First means defining success as liberating and empowering the physician to do what she needs to provide the best care for her patients and never standing in the way of the patient-physician relationship.

Clinical First means being usable enough that the physician can document her clinical thinking and decision-making without resorting to paper, and then being smart enough that she can pull it up a few months later to refresh her memory in seconds.

Clinical First means being intuitive enough that hours of training are unnecessary. After all, if the EHR were truly built to support the delivery of care, why would an expert need to go through extensive training to use it?

Clinical First means allowing a physician to document every med, problem, history, and allergy the patient rattles off during a new visit – without interrupting the conversation flow and thought process of the physician.

And most of all, Clinical First means trusting that the physician is already doing everything she can to deliver excellent care to her patients, and that the onus on technology is to make doing so easier.

For more on how we’ve built a Clinical First EHR that also satisfies Meaningful Use, see The Elation Philosophy.