I have created a new discussion area called 'Data Input' because this is the critical barrier that faces many physicians who use EMR systems. There is a constant debate raging about the best methods to input data into an EMR system.
Should one use a Tablet and pen because this more closely matches the way that physicians have always worked? Is speech recognition input critical if physicians are going to adopt EMR systems in significant numbers? Will it still be necessary to have access to a keyboard so that information can be keyed into the computer? How important is the data input interface in the process of the clinical encounter. My answer to these questions is Yes, Yes, Yes and Extremely.
As EMR systems mature, they will naturally evolve to match the style of practice of the physician user. If systems do not do this or are not capable of evolution becuase of initial design, they will become relics and will be absorbed by competitors or disappear entirely. In the same physician office, I can see a need for all three methods of data input. The pen and tablet work very fast in a setting that requires numerous quick decision e.g. prescribing. It is much quicker to move a pen over a touch interface than a mouse. Speech works well in situations that require extensive data input - e.g. dictation of a specialty consult letter or a medico-legal decritpion of a motor vehicle accident. The keyboard is the old standalone input device that has become indispensable and is good for entering the short encounter or a complex encounter that requires input of data into fields on a form or template - but does not need to be present on every computer. Obviously there is much cross-over between interfaces, but in my opinion, the average physician will require all three although at differing times.
You might make comment that you have survived without speech input, however if speech input were a viable option, how could you improve efficiency if it were available to you. Many developments are also taking place at present because of developments with the Tablet PC platform and handwriting recognition.
My final comment about interface is that of standards. We hear talk about standards for data transfer e.g. HL7, standards for coding e.g. ICD10, Snomed etc. How about standards for interface design in EMR systems? Collectively could a national body not review the most popular EMR systems currently available and put together a list of standard elements that should be present in each part of the encounter and make this information available to the vendor community. The concept behind this idea is that physicians should not have to completely relearn a new system if systems are changed or if locum physicians come into a practice for temporary relief. If there were some standards in the user interface for EMR, any physician should intuitively be able to use another EMR system without a day of training. Make sense?
This is a very interesting discussion area an one in which I have seen little written. If you would like to make a comment, please click on the 'Comments' link below this posting.